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El tratamiento correcto de carcinoma escamoso avanzado requiere de un manejo multidisciplinar entre cirujanos, anatomopatólogos, radioterapeutas y radiólogos. Los protocolos están claros cuando nos hallamos ante una enfermedad localizada, sin embargo, cuando la enfermedad es metastática no existe evidencia científica de los pasos a seguir. Presentamos una paciente con un carcinoma escamoso del ano con una única metástasis cutánea metacrónica que fue tratada con cirugía y radioterapia posterior con buena respuesta.

The right therapy of anal cancer needs a multidisciplinary management of surgeons, pathologists, radiotherapists and radiologist. The treatment of squamous cell carcinoma of the anal canal is well-known when the patient presents a locally disease, nevertheless, there is a lack of information with the advanced anal cancer. We report a case of a 74-year-old woman with a solitary methachronical cutaneous metastasis of anal cancer which responded perfectly to surgery and radiotherapy.

A correta terapêutica do câncer anal necessita de uma gestão multidisciplinar de cirurgiões, patologistas, radio terapeutas e radiologistas.O tratamento do carcinoma espinocelular do canal anal é bem conhecido quando o paciente apresenta uma doença local, porém, há uma falta de informação sobre o câncer anal avançado. Relatamos o caso de uma mulher de 74 anos com metástase cutânea metacrônica solitária de câncer anal que respondeu perfeitamente à cirurgia e à radioterapia.

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Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.

Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.

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ABSTRACT: Endometrial carcinoma is a very rare cause of cutaneous metastasis.The most frequent presentations of cutaneous metastasis are fast developing nodules or tumors, which are evi-dence of widespread dissemination in such patients.We report a case of scalp metastasis from an endometrial adenocarcinoma with a fatal prognosis. (AU)

RESUMO: O carcinoma endometrial é uma causa rara de metástases cutâneas.A apresentação mais frequente de metástases cutâneas são nódulos ou tumores de rápido desenvolvimento, que evidenciam uma disseminação generalizada nesses pacientes.Relatamos um caso de metástase no couro cabeludo de um adenocarcinoma endometrial com prognóstico fatal. (AU)

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RESUMEN Las metástasis cutáneas (MC) constituyen una manifestación infrecuente de neoplasias internas. Su diagnóstico requiere un alto índice de sospecha clínica, pues los hallazgos pueden ser sutiles. Estas ponen de manifiesto la presencia de un tumor maligno diseminado y pueden permitir el diagnóstico de neoplasias internas no conocidas, o indicar la diseminación o recurrencia de otras ya diagnosticadas. La MC del carcinoma de ovario suele aparecer en enfermedad avanzada e indican un mal pronóstico.Su reconocimiento temprano puede llevar a un diagnóstico preciso y rápido, con el consiguiente tratamiento oportuno, aunque en la mayoría de los casos son indicativas de un pronóstico infausto.

SUMMARY Cutaneous metastases are an infrequent manifestation of internal neoplasms. Its diagnosis requires a high index of clinical suspicion, since the findings can be subtle. These reveal the presence of a disseminated malignant tumor and can allow the diagnosis of unknown internal neoplasms, or indicate the dissemination or recurrence of others already diagnosed. MC of ovarian carcinoma usually appears in advanced disease and may indicate a poor prognosis. Early recovery can carry out an accurate and rapid diagnosis, with timely emergency treatment, although in most cases they are indicators of an unfortunate prognosis.

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Breast cancer spreading to different organs have been related to different molecules and mechanisms, but cutaneous metastasis remains unexplored. Increasing evidence showed that MUC1 and some of its carbohydrate associated antigens may be implicated in breast cancer metastasis. In this study we analyzed these tumor markers in order to identify breast cancer cutaneous metastatic profiles. A cohort of 26 primary tumors from breast cancer patients with cutaneous metastases were included; also, cutaneous and lymphatic node metastatic samples and primary tumors from breast cancer patients without metastases were analysed. Immunohistochemical (IHC) studies demonstrated that both underglycosylated MUC1 (uMUC1) and sialyl Lewis x (sLex) to be positively associated with cutaneous metastatic primary tumors (p < 0.05). Notably, a high percentage of tumors with cutaneous metastases were characterized as triple negative and Her2+ tumors (37.5 % and 29 %, respectively). Some discordant results were found between primary tumors and their matched cutaneous metastases. To determine if MUC1 variants may be carriers of carbohydrate antigens, subcellular fractions from a cutaneous metastatic lesion were obtained, immunoprecipitated and analyzed by Western blot. We found that the isolated uMUC1 with a molecular weight of>200 kDa was also the site for binding of anti-sLex MAb; in coincidence, a high correlation of positive IHC expression of both markers was observed. Our findings confirm that breast cancer cutaneous metastases were associated to highly malignant primary tumors and sustain the hypothesis that u-MUC1 and sLe x may drive breast cancer cutaneous metastases.

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The CSF-470 cellular vaccine plus BCG and rhGM-CSF increased distant metastases-free survival in cutaneous melanoma patients stages IIB-IIC-III relative to medium dose IFN-α2b (CASVAC-0401 study). Patient-045 developed a mature vaccination site (VAC-SITE) and a regional cutaneous metastasis (C-MTS), which were excised during the protocol, remaining disease-free 36 months from vaccination start. CDR3-TCRß repertoire sequencing in PBMC and tissue samples, along with skin-DTH score and IFN-γ ELISPOT assay, were performed to analyze the T-cell immune response dynamics throughout the immunization protocol. Histopathological analysis of the VAC-SITE revealed a highly-inflamed granulomatous structure encircled by CD11c+ nested-clusters, brisk CD8+ and scarce FOXP3+, lymphocytes with numerous Langhans multinucleated-giant-cells and macrophages. A large tumor-regression area fulfilled the C-MTS with brisk lymphocyte infiltration, mainly composed of CD8+PD1+ T-cells, CD20+ B-cells, and scarce FOXP3+ cells. Increasing DTH score and IFN-γ ELISPOT assay signal against the CSF-470 vaccine-lysate was evidenced throughout immunization. TCRß repertoire analysis revealed for the first time the presence of common clonotypes between a VAC-SITE and a C-MTS; most of them persisted in blood by the end of the immunization protocol. In vitro boost with vaccine-lysate revealed the expansion of persistent clones that infiltrated the VAC-SITE and/or the C-MTS; other persistent clones expanded in the patient's blood as well. We propose that expansion of such persistent clonotypes might derive from two different although complementary mechanisms: the proliferation of specific clones as well as the expansion of redundant clones, which increased the number of nucleotide rearrangements per clonotype, suggesting a functional antigenic selection. In this patient, immunization with the CSF-470 vaccine plus BCG and rhGM-CSF induced a T-cell repertoire at the VAC-SITE that was able to infiltrate an emerging C-MTS, which resulted in the expansion of a T-cell repertoire that persisted in blood by the end of the 2-year treatment.

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BACKGROUND AND OBJECTIVE: Cutaneous metastases (CMs) account for 2% of skin tumors and their incidence varies between 0.7% and 9% in patients with cancer. The objective of this study was to describe and analyze the demographic, clinical, and histopathologic characteristics of CM in patients who visited 2 hospitals in the Santiago de Chile metropolitan region. MATERIAL AND METHOD: We performed a retrospective, descriptive, analytical, observational, cross-sectional study. We reviewed the pathology reports, patient records, pathology slides, and dates of death for diagnosed cases of CM from the anatomic pathology departments of 2 hospitals in the Santiago de Chile metropolitan region between 2015 and 2017. RESULTS: Ninety-six patients with CM were included in the study; 60.42% were women and 39.58% were men. The mean (SD) age was 67.95 (13.74) years, with a range of 28 to 96 years. The most common primary tumor was melanoma in 27.08% of cases (n=26), followed by breast cancer (18.75%, n=18), and adenocarcinoma (15.63%, n=15). The median time between diagnosis of the tumor and cutaneous metastasis was 9 months. Patients with CM of melanoma had a higher survival rate than patients with metastasis of other primary tumors (P<.05). A histopathologic study of 91 slides showed that diffuse infiltration of the tissue with tumor cells was the most common pattern and vascular invasion was rare. CONCLUSIONS: The results are similar to those found worldwide. CM is a rare manifestation of internal tumors. It presents mainly at an advanced age and is equally prevalent in both sexes.

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Skin metastases are a rare event in patients with cervical cancer. One form of such metastasis is carcinomatous lymphangitis, which is a rare presentation of skin metastases. Here we report a woman with cervical cancer diagnosed cutaneous lymphangitic carcinomatosis.

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INTRODUCCIÓN: El cáncer colorrectal es un gran problema de salud por su alta incidencia y mortalidad. Las metástasis cutáneas son raras, con una incidencia < 5%. CASO CLÍNICO: Varón con antecedente de colectomía por neoplasia de colon que 6 años después presenta una lesión cutánea. La biopsia informa de metástasis colónica, por lo que se realiza resección quirúrgica radical. La anatomía patológica confirma un adenocarcinoma moderadamente diferenciado compatible con metástasis colónica. DISCUSIÓN Y CONCLUSIONES: Las metástasis cutáneas son raras y cuando aparecen nos indican una enfermedad avanzada, por lo que es importante un alto índice de sospecha en pacientes de riesgo para un diagnóstico precoz. INTRODUCTION: Colorectal cancer is a big health problem due to its high incidence and mortality. Cutaneous metastases are rare with an incidence < 5%. CLINICAL CASE: A male with a history of colectomy due to colon cancer, who 6 years later presented a cutaneous lesion. The biopsy reported colonic metastasis, so radical surgical resection was performed. The pathological anatomy confirmed a moderately differentiated adenocarcinoma compatible with colonic metastasis. DISCUSSION AND CONCLUSION: Cutaneous metastases are rare and when they appear they indicate an advanced disease, for that reason is important a high index of suspicion in patients at risk, for an early diagnosis.

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Cholangiocarcinoma accounts for less than 2% of all malignant neoplasms. Its cutaneous metastases are extremely rare, accounting for 0.0002% of all cases. The ventriculoperitoneal (VP) shunt has been considered a potential route for tumor dissemination. This type of tumor proliferation has been well documented in patients with intra-abdominal metastases secondary to brain tumors and, less frequently, brain metastases secondary to intra-abdominal tumors. In spite of that, there are few reports of cutaneous metastases along the VP shunt catheter trajectory. We present the case of a cholangiocarcinoma cutaneous metastasis at the VP shunt trajectory as the first clinical sign of this type of tumor. The patient had undergone the shunt insertion 4 years earlier due to a hydrocephaly secondary to a subarachnoid hemorrhage. After diagnosis, she was referred to chemotherapy and oncology follow-up. In the literature, 30 cases of cutaneous metastasis of cholangiocarcinoma were reported. Dissemination has been described involving percutaneous biliary drainage and distant sites. However, the case presented in this study alerts us about the possibility of cutaneous metastasis of intra-abdominal tumors in the trajectory of VP shunt catheters.

O colangiocarcinoma representa menos de 2% das neoplasias malignas. Sua metástase cutânea é extremamente rara, representando 0.0002% dos casos. A derivação ventrículo-peritoneal (DVP) tem sido considerada uma via potencial para a disseminação dos tumores. Essa propagação tumoral já foi bem descrita em pacientes com tumores do sistema nervoso central e metástases intra-abdominais e, menos frequentemente, em metástases cerebrais secundárias a tumores intra-abdominais. Apesar disso, a presença de metástases cutâneas ao longo da trajetória do cateter de DVP é pouco relatada. Apresentamos o caso de uma paciente portadora de DVP há quatro anos devido a uma hidrocefalia secundária à hemorragia subaracnoide e que apresentou metástases cutâneas de colangiocarcinoma na trajetória do cateter de derivação como o primeiro sinal clínico do tumor. Após o diagnóstico, ela foi encaminhada para quimioterapia e acompanhamento com oncologia. Na literatura, foram relatados 30 casos de metástases cutâneas de colangiocarcinoma. Em geral, a disseminação pode envolver locais distantes ou cateteres de drenagem biliar percutânea. No entanto, o caso descrito neste estudo nos alerta sobre a possibilidade de metástases cutâneas de tumores intra-abdominais na trajetória de cateteres de DVP.

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Resumen Caso clínico: paciente de 73 años de edad, con diagnóstico de adenocarcinoma ductal infiltrante en la mama izquierda. Se trató con mastectomía total, linfadenectomía axilar y quimioterapia. Diez años después le aparecieron un linfedema en el brazo izquierdo y hombro congelado. El linfedema estaba muy indurado y eritematoso, con numerosas lesiones costrosas y sobreinfectadas. La biopsia cutánea mostró infiltración neoplásica debida al carcinoma mamario y reporte de aumento de Ca 15.3. En el escáner cérvico-tóraco-abdomino-pélvico se observó derrame pleural izquierdo masivo, con atelectasia pulmonar subyacente y múltiples erosiones óseas, compatible con afectación tumoral. Tras recibir quimioterapia paliativa disminuyó temporalmente la infiltración cutánea tumoral. Conclusión: el carcinoma mamario es uno de principales cánceres que afectan a la mujer. Sus metástasis cutáneas son del orden de 37% a 5 años. El carcinoma en coraza es una variedad excepcional (3%), de evolución lenta, sin daño sistémico. Las pacientes con cáncer de mama deben tener un seguimiento estrecho postmastectomía y ante la sospecha de metástasis cutánea, diagnosticarla oportunamente para ofrecerles la opción del tratamiento temprano.

Abstract Clinical case: patient of 73 years of age, with diagnosis of infiltrating ductal adenocarcinoma in the left breast in 2004; it was treated with total mastectomy, axillary lymphadenectomy and chemotherapy; 10 years later, she had induration and erythema in the mastectomy area, with some superficial necrotic lesions and cutaneous infiltration to the right breast. In the left arm: indurated lymphedema, with numerous crusted, superficial and superinfected lesions. The skin biopsy showed neoplastic infiltration due to mammary carcinoma and an increase in Ca 15.3. In the cervico-thoraco-abdominal-pelvic scan, massive left pleural effusion was observed, with underlying pulmonary atelectasis and multiple bone erosions, compatible with tumor involvement. After receiving palliative chemotherapy, the cutaneous infiltration of the tumor decreased temporarily. Conclusion: mammary carcinoma is one of the main cancers that affect women. Their cutaneous metastases are of the order of 37% at 5 years. Cutaneous carcinoma is an exceptional variety (3%), of slow evolution, without systemic damage. Patients with breast cancer should have a close postmastectomy follow-up and, in case of skin metastasis suspicion, diagnose it in a timely manner to offer them the option of early treatment.

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Se describe el caso clínico de una anciana de 85 años de edad, quien fue ingresada en el Servicio de Medicina Interna del Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany", de Santiago de Cuba por presentar dolor lumbar, disuria y hematuria, además de un tumor de 6 cm de diámetro en la pared abdominal, región suprapúbica, desde hacía 6 meses. Se efectuó biopsia de la lesión, cuyos resultados informaron carcinoma urotelial infiltrante de alto grado, por lo cual fue trasladada al Servicio de Urología donde se le realizarían los exámenes propios de la especialidad. El diagnóstico se confirmó mediante la cistoscopia y el análisis histopatológico. No se llevó a cabo el tratamiento por negativa de sus familiares.

The case report of an 85 years old woman is described who was admitted in the Internal Medicine Service of "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba due to low back pain, dysuria and hematuria, besides a 6 cm diameter tumor in the abdominal wall, suprapubic region, for 6 months. The biopsy of the lesion was carried out which results revealed high degree infiltrative urothelial carcinoma, reason why she was transferred to the Urology Service where the exams characteristic of the specialty would be carried out. The diagnosis was confirmed by means of the cystoscopy and the histopathological analysis. The treatment was not carried out due to her relatives refusal.

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Background: Primary lung tumors in the cats are rare and pulmonary metastatic cancer is more common. Primary lung neoplasms are highly aggressive and tend to metastasize particularly to the regional lymph nodes, pleura, mediastinum bones, muscles, heart, brain and spleen. Digital is the most common metastatic site of primary lung tumors in cats. However, cutaneous metastases of internal tumors are rare in cats. This case reported an unusual cutaneous metastasis in a cat with bronchogenic adenocarcinoma. Case: A 6-year-old, spayed, female, persian cat was presented for vomiting and anorexia. On physical examination, dyspnea was observed and respiratory sounds were decreased in the caudal portion of the right side of the chest on thoracic auscultation. A nodular lesion was found in the skin extending into the subcutaneous tissue of the chest on fifth thoracic vertebra. On lateral and ventrodorsal radiographs of the thorax, a diffuse interstitial pattern involving the medial and right-caudal lung lobes was noted. Hematological and biochemistry analysis were normal. Antigen and antibody tests for feline leukemia virus (FeLV) and feline immunodeciency virus (FIV) were negative. Pulmonary edema was suspected, but respiratory efforts became worse despite medication. Due to the progressive severity of clinical signs, refractory to medication, an exploratory intercostal thoracotomy was...(AU)

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Background: Primary lung tumors in the cats are rare and pulmonary metastatic cancer is more common. Primary lung neoplasms are highly aggressive and tend to metastasize particularly to the regional lymph nodes, pleura, mediastinum bones, muscles, heart, brain and spleen. Digital is the most common metastatic site of primary lung tumors in cats. However, cutaneous metastases of internal tumors are rare in cats. This case reported an unusual cutaneous metastasis in a cat with bronchogenic adenocarcinoma. Case: A 6-year-old, spayed, female, persian cat was presented for vomiting and anorexia. On physical examination, dyspnea was observed and respiratory sounds were decreased in the caudal portion of the right side of the chest on thoracic auscultation. A nodular lesion was found in the skin extending into the subcutaneous tissue of the chest on fifth thoracic vertebra. On lateral and ventrodorsal radiographs of the thorax, a diffuse interstitial pattern involving the medial and right-caudal lung lobes was noted. Hematological and biochemistry analysis were normal. Antigen and antibody tests for feline leukemia virus (FeLV) and feline immunodeciency virus (FIV) were negative. Pulmonary edema was suspected, but respiratory efforts became worse despite medication. Due to the progressive severity of clinical signs, refractory to medication, an exploratory intercostal thoracotomy was...

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Breast cancer is the most common cause of cutaneous metastases from internal malignancies. Generally, the neoplastic cells are located in the dermis or hypodermis, while a finding of transepidermal elimination on cutaneous metastases is exceptional. In this report we present a patient with perforating cutaneous metastases from breast cancer with mucin 1 expression. Cutaneous, bone, lung, and hepatic lesions were detected two years after the diagnosis of the primary tumor.

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This article relates a case of a three-year-old male Rottweiler dog, with diagnostic of fibroblastic osteosarcoma on left femur distal third, associated with cutaneous metastasis. It"s detached the rare occurrence of this found in dog, being an aggravating factor for the prognostic of this disease.

Relata-se neste trabalho o caso de um cão Rottweiler, macho, de três anos de idade, com diagnóstico de osteossarcoma fibroblástico em terço distal de fêmur esquerdo, associado a metástase cutânea. Ressalta-se a insólita ocorrência deste achado em cães, sendo este um fator agravante para o prognóstico desta enfermidade.