Cutaneous metastasis of renal pelvic urothelial carcinoma mimicking cutaneous angiosarcoma

A 74-year-old woman presented with a rapidly growing plaque on her neck and chest, which had been noticed 1  month before (Fig. 1A and B). Physical examination found a purpuric, indurated plaque widely distributed on the neck and chest, reminiscent of angiosarcoma. CT revealed a large lesion on the right side of the neck and chest, inducing tracheal shifting and stenosis (Fig. 2A). Enlarged lymph nodes (LNs) within the right neck, mediastinum and para-aortic region and a mass in the left renal pelvis were also seen (Fig. 2B). We suspected cutaneous angiosarcoma with multiple metastases and the tracheal stenosis prompted us to plan chemoradiation therapy immediately after histological confirmation. However, histological analyses revealed multiple nests composed of round-shaped, atypical cells with frequent tumour cell invasion into blood vessels and vascular destruction (Fig. 3A and B). The tumour cells were positive for CK7 and CK20 (Fig. 3C) but negative for CD31 and D2-40. D2-40 staining also revealed frequent invasion of tumour cells into lymph vessels (Fig. 3D). Urine cytology detected similar tumour cells (Fig. 3E), suggesting the plaque to be cutaneous metastasis from left renal pelvic urothelial carcinoma (UC). Her rapidly deteriorating condition resulted in death within a month after diagnosis.
Source: Japanese Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research