Arce F P, Pinto J, Portero I, Echevarría S, Val-Bernal J F
Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain.
J Cutan Pathol. 2000 May;27(5):262-7. doi: 10.1034/j.1600-0560.2000.027005262.x.
Metastases of chondrosarcoma to the skin are uncommon. We report a case of dedifferentiated chondrosarcoma that manifested as cutaneous metastases and had an outcome of three weeks. A 69-year-old male presented with two cutaneous nodules, one in the chest and other in the inguinal area. The punch biopsy of the latter showed a poorly differentiated mesenchymal metastatic tumor. Shortly before death, an X-ray revealed a proximal epiphyseal lesion in the right humerus, radiographically interpreted as chondrosarcoma. The autopsy showed this lesion to be a dedifferentiated chondrosarcoma whose nonchondroid mesenchymal part was akin, histologically and immunohistochemically, to the cutaneous metastases. While ten previous reports of chondrosarcoma metastatic to the skin are known, we believe that this is the first case to report the cutaneous metastases of the dedifferentiated variety. Furthermore, skin metastasis preceding the diagnosis of chondrosarcoma has not been previously reported. The fact that one part of this kind of tumor can be highly undifferentiated or, else, differentiated along lines not usually reminiscent of bone tumors, can make the diagnosis of such cases extremely difficult. Most chondrosarcomas metastatic to the skin arise in bones of the extremities, including the hand. The most common type of tumor is conventional chondrosarcoma. These metastases can be either single or multiple with a slight predilection for the head and neck region. Most patients die in a mean time of 6 months after the appearance of cutaneous metastases.
软骨肉瘤皮肤转移并不常见。我们报告一例去分化软骨肉瘤，表现为皮肤转移，病程为三周。一名69岁男性患者出现两个皮肤结节，一个在胸部，另一个在腹股沟区。对后者进行的穿刺活检显示为低分化间叶性转移瘤。患者死亡前不久，X线检查显示右肱骨近端骨骺病变，影像学诊断为软骨肉瘤。尸检显示该病变为去分化软骨肉瘤，其非软骨性间叶部分在组织学和免疫组织化学上与皮肤转移瘤相似。虽然此前已知有10例软骨肉瘤皮肤转移的报道，但我们认为这是首例报道去分化型软骨肉瘤的皮肤转移。此外，此前尚未有软骨肉瘤诊断前出现皮肤转移的报道。这种肿瘤的一部分可能高度未分化，或者沿通常不使人联想到骨肿瘤的方向分化，这会使此类病例的诊断极其困难。大多数转移至皮肤的软骨肉瘤发生于四肢骨骼，包括手部。最常见的肿瘤类型是普通型软骨肉瘤。这些转移灶可为单发或多发，稍多见于头颈部区域。大多数患者在出现皮肤转移后平均6个月内死亡。
