Białecki Marcin, Białecka Agnieszka, Męcińska-Jundziłł Kaja, Adamska Urszula, Kasperska Anna, Czajkowski Rafał
Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
Chair of Dermatology, Sexually Transmitted Diseases and Immunodermatology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
Pol J Radiol. 2018 Feb 4;83:e63-e67. doi: 10.5114/pjr.2018.73307. eCollection 2018.
Disseminated malignancies are a diagnostic and therapeutic challenge that is often encountered in radiology. Finding the primary tumour is crucial for planning proper surgical and oncological treatment. Computed tomography (CT) of the thorax and abdomen is typically the initial examination. However, abdominal magnetic resonance imaging (MRI) or positron emission tomography (PET/CT) or PET/MRI are often subsequently performed. Histopathological examination of metastatic tumours is performed as well, followed by immunohistochemistry. The aim of the report was to present diagnostic workup in a rare case of skin metastases.
A 72-year-old patient was admitted to a dermatology ward because of skin lesions - violaceous nodules localised on the hair-covered skin of the head. On abdominal CT, a generalised neoplastic process with metastases in the liver, pancreas, adrenal glands, lymph nodes, bones, thoracic wall, and a suspected metastasis in the right breast was revealed. Histopathology of the skin nodules confirmed a neuroendocrine tumour. Metastases of a pancreatic neuroendocrine tumour or small-cell lung cancer were suspected on immunohistochemistry. The patient died before we were able to localise the primary source of the tumour and provide treatment.
Skin metastases are relatively rare, aggravate the prognosis, and usually indicate spread of the neoplastic process in the internal organs. It is not always possible to localise the primary tumour using radiological imaging. In such cases, co-operation with the pathologist is crucial as are the results of histopathological and immunohistochemical examinations.
播散性恶性肿瘤是放射学中经常遇到的诊断和治疗难题。找到原发性肿瘤对于规划适当的手术和肿瘤治疗至关重要。胸部和腹部计算机断层扫描（CT）通常是初始检查。然而，随后通常会进行腹部磁共振成像（MRI）或正电子发射断层扫描（PET/CT）或PET/MRI。也会对转移性肿瘤进行组织病理学检查，随后进行免疫组织化学检查。本报告的目的是介绍一例罕见的皮肤转移瘤的诊断检查。
一名72岁患者因皮肤病变——位于头部有毛发覆盖皮肤的紫红色结节而入住皮肤科病房。腹部CT显示有全身性肿瘤病变，肝脏、胰腺、肾上腺、淋巴结、骨骼、胸壁有转移，右乳疑似有转移。皮肤结节的组织病理学证实为神经内分泌肿瘤。免疫组织化学怀疑为胰腺神经内分泌肿瘤或小细胞肺癌转移。患者在我们能够确定肿瘤的原发部位并提供治疗之前死亡。
皮肤转移相对罕见，会使预后恶化，通常表明肿瘤病变已扩散至内脏器官。使用放射影像学并不总是能够确定原发性肿瘤。在这种情况下，与病理学家合作至关重要，组织病理学和免疫组织化学检查结果也同样重要。
