Fogaça M F, Fedorciw B J, Tahan S R, Johnson R, Federman M
Department of Pathology, New England Deaconess Hospital, Boston, Massachusetts 02115.
J Cutan Pathol. 1993 Oct;20(5):455-8. doi: 10.1111/j.1600-0560.1993.tb00671.x.
We report a case of a 33-year-old woman who presented with the rapid development of multiple dermal and subcutaneous nodules on the chest, back, abdomen, axilla, neck, and scalp. These nodules were firm, tender, and non-ulcerated and measured from 0.2 to 1.2 cm in diameter. A punch biopsy of one of the subcutaneous nodules in the scalp showed a poorly differentiated carcinoma in the reticular dermis with light microscopic, immunohistochemical, and ultrastructural features supporting neuroendocrine differentiation. The past medical history was significant for a recent total abdominal hysterectomy for carcinoma of the cervix at another hospital, originally characterized as a poorly differentiated adenocarcinoma of the cervix and lower uterine segment. Review of the microscopic slides of the uterine neoplasm revealed features suggesting a more appropriate classification as a primary neuroendocrine carcinoma; this was subsequently confirmed by immunophenotyping and ultrastructural evaluation. This is the first reported case of a uterine neuroendocrine carcinoma metastasizing exclusively to the skin. It further illustrates the important contribution of dermatopathology to the understanding of a systemic pathologic process.
我们报告一例33岁女性病例，该患者胸部、背部、腹部、腋窝、颈部和头皮迅速出现多个皮肤和皮下结节。这些结节质地坚硬、有压痛且未发生溃疡，直径在0.2至1.2厘米之间。对头皮下一个结节进行的打孔活检显示，网状真皮层有低分化癌，其光镜、免疫组化和超微结构特征支持神经内分泌分化。既往病史显示，患者近期在另一家医院因宫颈癌接受了全腹子宫切除术，最初诊断为宫颈和子宫下段低分化腺癌。对子宫肿瘤的显微镜切片复查显示，其特征提示更合适的分类应为原发性神经内分泌癌；随后通过免疫表型分析和超微结构评估得以证实。这是首例报告的仅转移至皮肤的子宫神经内分泌癌病例。它进一步说明了皮肤病理学对理解全身性病理过程的重要贡献。
