Adenocarcinoma of the skin arising in the capillitium – a diagnostic dilemma in the biopsy practice

Overview

Bartoš V. Adenocarcinoma of the skin arising in the capillitium – a diagnostic dilemma in the biopsy practice Skin metastases affect 0.6–10.4% of patients with malignant oncological disease. Most of them are diagnosed in subjects with an already known primary cancer. When cutaneous metastasis is suspected, it is extremely important for pathologist to have relevant clinical information about the patient. This will help him to determine the origin of the tumor, but also to solve the possible dilemma, whether it is really a metastasis or a primary cutaneous adnexal carcinoma. A 78-year-old woman was found to have a skin tumor resected from the parietal area with a presumed clinical diagnosis of basal cell carcinoma. No other information was given in the Biopsy examination request form and referring surgeon could not provide any information on the patient either. Histology revealed adenocarcinoma arranged in tubular-trabecular growth pattern. It was immunohistochemically positive for cytokeratin 7, estrogen receptor, E-cadherin and GATA-3 a negative for cytokeratin 5/6, protein p63, progesteron receptor, mammaglobin, cytokeratin 20 and TTF-1. After additional consultation with several workplaces the pathologist found that the patient suffered from an advanced stage of breast cancer. So that was skin metastasis of mammary cancer. This work shows that cutaneous metastases are already a manifestation of an advanced stage of oncological disease, usually accompanied by metastatic involvement of other organs. This also demonstrates how the absence of clinical data about the patient makes the diagnostic process difficult for pathologist and vice versa, how adequate clinical information would greatly help him in biopsy diagnosis.

Keywords:

breast adenocarcinoma – cutaneous metastases – skin adnexal tumors