Cutaneous metastases of internal malignancies: a clinicopathologic study.

BACKGROUND: Secondary tumor deposits in the skin represent advanced malignancy and are of uncommon occurrence. The clinical presentation of these lesions is variable, and the clinical impression is rarely correct, except in cases of known primary malignancies. AIM: To summarize the clinical and histopathological findings in biopsy-proven cutaneous metastases. METHODS: The present study has analyzed 14 cases of cutaneous metastases from internal malignant neoplasms, excluding hematolymphoid neoplasms. The clinical parameters analyzed include presentation of deposits and their relation to the primary tumor. The histological features of cutaneous metastases were compared with the primary tumors and the frequency of common features in them were evaluated. RESULTS: Cutaneous metastases from internal organ malignancies showed a prevalence rate of approximately 2%. Eight cases (56%) presented as primary manifestations of the tumor; biopsy evaluation in these cases suggested the possible primary tumor site and triggered further evaluation and imaging studies. Four patients, undergoing treatment for a known malignant tumor, had recurrence of the tumor in the form of cutaneous metastatic deposits. In the remaining two patients, cutaneous metastases of the tumor appeared simultaneously with the primary neoplasm and represented a higher stage of malignancy. CONCLUSIONS: Skin biopsy findings were significant in all cases. The morphological patterns of cutaneous metastases corresponded with the primary tumors and their evaluation helped localize unknown primary malignancies. In cases with known primaries, cutaneous metastases upstaged the malignancy and affected the prognosis.

Panniculitis: clinical overlap and the significance of biopsy findings.

BACKGROUND: Panniculitides are well-recognized clinicopathologic entities but the non-specificity of their clinical and pathological features often troubles the diagnostician. METHODS: This study retrospectively evaluates the clinical overlaps and the significance of histological findings among various panniculitides. RESULTS: The clinical evaluation in 55 panniculitides cases suggested the diagnosis of typical erythema nodosum (EN) in 26 cases, atypical EN in 17 cases, atypical nodular vasculitis (NV) in two cases, soft tissue infection in five cases and five cases remained unclassified. Skin biopsy evaluation provided definite panniculitis diagnosis in 53 cases including EN (28 cases), leukocytoclastic vasculitis (seven cases), NV (four cases), superficial thrombophlebitis (ST) (two cases), eosinophillic panniculitis (EP) (three cases), infection-related panniculitis (five cases), and one case each of erythema nodosum leprosum (ENL), lupus panniculitis (LP), pancreatic fat necrosis and acne conglobata with two cases remaining unclassified. Histologically, 'predominantly septal' and 'mixed panniculitis' were the chief inflammatory patterns in EN cases, while mixed panniculitis was seen in most LCV cases and predominantly lobular and mixed panniculitis in NV cases. CONCLUSIONS: Biopsy evaluation of a panniculitis lesion is usually significant, and the application of a combination of histologic features rather than of a single biopsy finding or an inflammatory pattern is helpful in the diagnosis of panniculitis.