Menghani Sanjay V, Barbosa Alexandra, Sagerman Paul, Beal Matthew W, Scott Aaron
Internal Medicine, University of Arizona College of Medicine, Tucson, USA.
Pathology, Pathology Biomedical Consulting, Tucson, USA.
Cureus. 2020 Jan 27;12(1):e6781. doi: 10.7759/cureus.6781.
Cutaneous metastasis is a rare manifestation of advanced gastrointestinal (GI) cancers. Gastric adenocarcinoma rarely presents with cutaneous metastasis, as cutaneous manifestations occur in less than 1% of upper GI tract malignancies. Here, we present the case of a patient with advanced gastric cardia adenocarcinoma with metastasis to the right occipital region of the scalp. Following shave biopsy, the immunohistochemistry (IHC) and molecular profile of the scalp lesion were analyzed, both of which confirmed metastasis and guided the treatment approach. The lesion demonstrated programmed death ligand-1 (PD-L1), an immune checkpoint protein, positivity by IHC, which led to the recommendation for treatment with immunotherapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Clinicians should conduct dermatologic examinations in patients with a history of gastric cancer or who are currently undergoing chemotherapy for gastric cancer in order to monitor for disease progression or metastatic lesions. The aim of this report is to increase awareness of scalp metastasis as an indicator of advanced internal visceral carcinoma for earlier diagnosis and improved management of the condition.
皮肤转移是晚期胃肠道（GI）癌症的一种罕见表现。胃腺癌很少出现皮肤转移，因为在上消化道恶性肿瘤中，皮肤表现的发生率不到1%。在此，我们报告一例晚期贲门胃腺癌患者，其转移至头皮右枕部区域。在进行剃发活检后，对头皮病变进行了免疫组织化学（IHC）和分子特征分析，两者均证实为转移，并指导了治疗方法。该病变通过IHC显示程序性死亡配体-1（PD-L1），一种免疫检查点蛋白，呈阳性，这导致根据美国国立综合癌症网络（NCCN）指南推荐采用免疫疗法进行治疗。临床医生应对有胃癌病史或目前正在接受胃癌化疗的患者进行皮肤科检查，以监测疾病进展或转移病变。本报告的目的是提高对头皮转移作为晚期内脏癌指标的认识，以便早期诊断并改善对该疾病的管理。
