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Poster Session:PS 0572 ; Oncology : Lung Cancer with Revealing Skin Metastasis
( Miguel Arderius ),( Nayive Gomez ),( David Fortes ),( Alda Jordao ),( Gloria Silva ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Skin metastization is an uncommon manifestation of carcinomas (3-4% incidence in some series). Lung origin is more common in men (24 versus 4% in women, in recent meta-analysis), being the fi rst manifestation in 0.8% of cases. It appears in advanced stage and has poor prognosis. Case Presentation: 78 year old man, smoker, went to the ER because of the appearance, in the last 3 months, of 2 cutaneous nodules in the thorax, with progressive enlargement and infi ammatory signs. Concomitantly, he showed asthenia, adynamia, anorexia, exertional dyspnea and weight loss (10kg), symptoms the patient didn`t quite value, showing a very good Performance Status (Karnofsky scoring 70%). In observation, 2 solid subcutaneous nodules (3cm), parasternal, violaceous, ulcerated, non adherent, painful; and 2 similar nodules, smaller and non ulcerated, palpable in the inguinal regions. In the thorax radiography, peribronchial mass on the right, with irregular contour. Thoraco-abdomino-pelvic CT showed a perihilar mass (8cm) in the right lung, obliterating the anterior segment of the superior lobe; pulmonary artery compression; mediastinal pleura invasion; multiple adenomegalies; adrenal gland metastization; and subcutaneous masses in the anterior thoracic wall, abdominal wall and gluteal region. Analytically, elevated NSE (142μg/L). Bronchofi broscopy revealed complete bronchial obstruction, with the biopsy confi rming a Small Cell Carcinoma. The biopsies from the skin lesions had a mixed pattern (Combined Small Cell and Large Cell Neuroendocrine Carcinoma). He was discharged to Pneumological Oncology, where he started chemotherapy. Conclusion: Despite the fact that skin metastasis are rare, it`s timely recognition may be critical to the prognosis. The Internist should therefore be aware of its existence. In this case, the patient kept a good performance status despite the advanced disease.
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