Imaging in a rare case of neuroendocrine tumour with skin metastases
More details
Hide details
Publication date: 2018-02-04
Pol J Radiol, 2018; 83: 63-67
Purpose: 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.
Case report: 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.
Conclusions: 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.
Kamińska-Winciorek G, Wydmański J, Januszewski K et al. Dermoscopy of nodular skin metastases from the gastrointestinal primary cancer. Postepy Dermatol Alergol 2015; 32: 312-316.
Chauhan A, Sharma AK, Sunita BS. Cutaneous metastasis as primary presentation in unsuspected carcinoma esophagus: Report of two cases. J Cancer Res Ther 2015; 11: 667.
Hendifar AE, Marchevsky AM, Tuli R. Neuroendocrine tumors of the lung: current challenges and advances in the diagnosis and management of well-differentiated disease. J Thorac Oncol 2017; 12: 425-436.
Yao JC, Hassan M, Phan A et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008; 26: 3063-3072.
Krawczyk J, Świeboda-Sadlej A. Guzy neuroendokrynne (NET) ze szczególnym uwzględnieniem guzów neuroendokrynnych przewodu pokarmowego (GEP-NET) – diagnostyka i leczenie. Medycyna po Dyplomie 2010; 19: 40-47 [In Polish].
Bellizzi AM. Assigning site of origin in metastatic neuroendocrine neoplasms: A clinically significant application of diagnostic immunohistochemistry. Adv Anat Pathol 2013; 20: 285-314.
Krzakowski M, Meder J, Olszewski W. Neoplasms of unknow primary site Recommendations of the Polish Union of Oncology. J Oncol 2003; 53: 660-665.
Menda Y, O’Dorisio TM, Howe J et al. Localization of unknown primary site with 68Ga-DOTATOC PET/CT in patients with metastatic neuroendocrine tumor. J Nucl Med 2017; 58: 1054-1057.
Maxwell JE, Sherman SK, Menda Y et al. Limitations of somatostatin scintigraphy in primary small bowel neuroendocrine tumors. J Surg Res 2014; 190: 548-553.
Lewis RB, Lattin GE Jr., Paal E. Pancreatic endocrine tumors: Radiologic-clinicopathologic correlation. Radiographics 2010; 30: 1445-1464.
Buetow PC, Miller DL, Parrino TV et al. Islet cell tumors of the pancreas: clinical, radiologic, and pathologic correlation in diagnosis and localization. Radiographics 1997; 17: 453-472.
Kartalis N, Mucelli RM, Sundin A. Recent developments in imaging of pancreatic neuroendocrine tumors. Ann Gastroenterol 2015; 28: 193-202.
Rufini V, Baum RP, Castaldi P et al. Role of PET/CT in the functional imaging of endocrine pancreatic tumors. Abdom Imaging 2012; 37: 1004-1020.
Ruhlmann V, Ruhlmann M, Bellendorf A et al. Hybrid imaging for detection of carcinoma of unknown primary: A preliminary comparison trial of whole-body PET/MRI versus PET/CT. Eur J Radiol 2016; 85: 1941-1947.
Białecki M, Białecka A, Laskowska K et al. Contrast-enhanced ultrasonography in Crohn’s disease diagnostics. Hepatogastroenterology 2015; 62: 927-932.
Serafin Z, Karolkiewicz M, Gruszka M et al. High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media. Acta Radiol 2011; 52: 422-429.
Serafin Z, Białecki M, Białecka A et al. Contrast-enhanced ultrasound for detection of Crohn’s disease activity: Systematic review and meta-analysis. J Crohns Colitis 2016; 10: 354-362.
Bhosale PR, Menias CO, Balachandran A et al. Vascular pancreatic lesions: Spectrum of imaging findings of malignant masses and mimics with pathologic correlation. Abdom Imaging 2013; 38: 802-817.
Capurso G, Rinzivillo M, Bettini R et al. Systematic review of resection of primary midgut carcinoid tumour in patients with unresectable liver metastases. Br J Surg 2012; 99: 1480-1486.
Journals System - logo
Scroll to top