Abdominal papular zosteriform cutaneous metastases from endometrial adenocarcinoma

Abstract

⁎ Corresponding author. Department of Surgery, Clinical Hospital Center Zagreb, Kispaticeva 12, Zagreb, Croatia. E-mail address: augustin.goran@gmail.com (G. Augustin). We report an extremely rare case of abdominal papular zosteriform cutaneous metastases from endometrial adenocarcinoma. A 78-year-old woman had previously undergone hysterectomy and bilateral adnexectomy via lower midline laparotomy for FIGO stage IIIC endometrial adenocarcinoma. Postoperative therapy comprised systemic multidrug chemotherapy, radiotherapy (50 Gy), and transvaginal brachytherapy (25 Gy). Two years later, multiple red indurated papules developed in a dermatomal zosteriform distribution on the anterior abdominal wall at level T10–T12 bilaterally; the most abundant changes were near the laparotomy scar. These were identified when the patient presented to the Emergency Room with mechanical bowel obstruction and ascites (Fig. 1). Excisional biopsy showed circular islands of atypical glandular epithelial cells infiltrating the superficial and deep dermis, consistentwithmetastatic adenocarcinoma. The incidence of cutaneous metastases has increased from 2.7% in 1969 to 10% in recent years, due in part to a growing awareness of this condition, in part to a rise in cancer rates, and in part to longer survival times allowing skin metastases an opportunity to develop [1]. There are several morphologic types, including macules, papules, nodules, indurated plaques, purpuric plaques mimicking vasculitis, discoid lesions, and tumor nodes with telangiectasia. Cutaneous metastases of the abdominal wall are extremely rare. There are two forms. One is post surgical and can be incisional, portsite (trochar-site), or drain-site metastases due to inoculation and direct spread of the tumor, with fair survival measured in years after complete excision. The other form is due to natural history of the disease, usually indicating end-stage disease with limited survival. Often, the regions of cutaneous metastases coincide with the field of previous radiation therapy, which obliterates small lymphatic channels and thus facilitates the implantation of tumor cells. The incidence of skin metastases in endometrial carcinoma is unknown,