DIFFUSE SUBCUTANEOUS NODULES AS A FIRST SIGN OF A METASTATIC PULMONARY NEUROENDOCRINE TUMOR

Abstract

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Pulmonary neuroendocrine tumors are rare tumors that arise from cells of the endocrine and nervous systems with an incidence rate of 2/100,000 population/year in the United States, comprising 2% of all primary lung cancers. The most common described sites of metastases from Carcinoid tumors are liver , bone , and mediastinal lymph nodes . Subcutaneous metastases from carcinoid tumors are very rare. The behavior of these tumors depends upon their location within the lungs, whether they secrete hormones, or if they have metastasized. This tumors comprise a spectrum of progression, including: low grade neuroendocrine tumors , intermediate grade neuroendocrine tumors and high grade neuroendocrine tumors (large cell neuroendocrine tumors and small cell carcinomas) respectively. CASE PRESENTATION: A 72-year-old latin american female with a past medical history of breast cancer that was previously treated with chemotherapy and radiotherapy 10 years ago. Patient came to the institution due to multiple skin progressively painful enlarged skin nodules, fatigue, generalized weakness and melena of several days of evolution. Physical examination revealed multiple skin nodules measuring from 1 to 4 cm in diameter with the largest measuring 3 x 4 cm in the left neck area extremely tender and firm. A biopsy was performed with histopathology consistent with a carcinoid tumor with moderate amount of cytoplasm and eccentric nuclei. Immunohistochemistry of the neoplastic cells exhibited similar positive staining for the neuroendocrine markers chromogranin A and synaptophysin with positive markers for CD56, pankeratin with a Ki67 of 70%. Staining of the neoplastic cells also was positive for thyroid transcription factor 1 (TTF-1) . These results were consistent with cutaneous metastasis from pulmonary carcinoid tumor by which same cells were also seen by stomach biopsy of nodules present as well. DISCUSSION: Cutaneous metastases of internal malignancies are more common from carcinomas of the lungs, gastrointestinal tract, and breasts. The histology of cutaneous carcinoid metastases typically resembles the primary lesion. However, identifying source is a major role in this cases. Occasionally, the cutaneous metastasis will develop directly over the underlying malignancy but thats not the case in the majority of cases. Thats were histologic stains and cells characteristics play a major role. Our case of cutaneous metastasis of a carcinoid tumor presented as multiple tender subcutaneous nodules. The histology of the lesion was consistent with the known carcinoid tumor of the lung. CONCLUSIONS: Even though neuroendocrine tumors are rare, obtaining an concise clinical history , addressing risk factors and pertinent findings of medical presentation with the appropriate immunohistochemical panels is the cornerstone of this challenging cases when primary site is in doubt. Reference #1: Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practiceCaplin ME, Baudin E, Ferolla P, et al. Reference #2: Primary pulmonary carcinoid tumor: a long-term single institution experience/Primary pulmonary carcinoid tumor.Ryan F. Herde, MD, MS1, Kristine E. Kokeny, MD2, Chakravarthy B. Reddy, MD3, Wallace L. Akerley, MD4, Nan Hu, PhD5, Jonathan P. Boltax, MD3, and Ying J. Hitchcock, MD2. Reference #3: Cutaneous Metastasis of a Pulmonary Carcinoid Tumor Cutis. 2017 May;99(5):E13-E15 DISCLOSURES: No relevant relationships by Christian Castillo Latorre, source=Web Response No relevant relationships by Michael Cruz, source=Web Response No relevant relationships by Omar Mendez Melendez, source=Web Response No relevant relationships by Kelvin Rivera Manzano, source=Web Response