Case Letter
Skin metastasis of malignant mesothelioma
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 638 "Ancho" => 1505 "Tamanyo" => 157064 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous metastasis of malignant pleural mesothelioma is rare. We herein report a case of malignant mesothelioma with distant cutaneous metastasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 78-year-old man, who was working as a welder and was exposed to asbestos, visited the Internal Medicine department at our hospital while complaining of shortness of breath for the previous six months. He underwent an aspiration biopsy of the right chest wall. Neoplastic monomorphous cells with eosinophilic or vacuolated cytoplasm and atypical nuclei arranged in a solid or cobblestone pattern. Immunohistochemistry was strongly positive for epithelial membrane antigen and vimentin, focal positivity for AE1/3, calretinin, D2-40, and Wilms tumor-1, but negative for carcinoembryonic antigen, thyroid transcription factor-1, and cytokeratin 5/6. A diagnosis of malignant pleural mesothelioma was made (T3N0M0, stage 3), and the patient was treated with chemotherapy (pemetrexed and carboplatin). However, five months after finishing chemotherapy, he noticed a firm nodule on the left axilla and was referred to our department. Physical examination showed a solitary dermal nodule on the left axilla. Histological examination of the totally resected tumor showed similar atypical epithelioid tumor cells with a number of mitoses (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Immunohistochemistry showed a similar pattern with pleural biopsy with intense staining for vimentin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), as well as focal positivity for AE1/AE3 and D2-40; however, calretinin, a marker of mesothelioma cell, was not detected. Thereafter, three months later, skin nodules further appeared on the lower abdomen (two nodules sized 12 mm and 17 mm in diameter) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a), on the left chest (sized 20 mm one nodule) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>b), and on the right chest (50 × 35 mm one nodule). Chemotherapy was ceased and best supportive care was chosen.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Malignant mesothelioma is a rare neoplasm of the serosal membranes predominantly of the pleura and peritoneum. The incidence of malignant mesothelioma is increasing, especially in patients exposed to asbestos. The current patient had been working in construction areas for a long time, which therefore led to his exposure to asbestos.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cutaneous metastasis of malignant mesothelioma is relatively rare and can occur in three different ways; i) Regional spread via lymphatics, ii) Direct extension within surgical scars such as needle track, and iii) Distant metastasis via hematogenous spread.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the present case, a metastatic nodule appeared on the axilla, irrelevant to the aspiration biopsy site. Distant skin metastasis is relatively rare. Ward et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reviewed 20 cases of malignant mesothelioma metastatic to the skin, excluding cases of direct extension or regional spread. The average time from the original diagnosis of malignant mesothelioma to cutaneous metastasis was six months. The most commonly involved site was the face, followed by the scalp and chest. Metastatic skin lesions mostly occur as subcutaneous nodules, and multiple lesions are often observed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the present case, subcutaneous nodules increased in number within only three months. Skin lesions can also be disseminated.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the present case, skin metastasis initially appeared five months after the diagnosis of malignant pleural mesothelioma; however, metastasis can be delayed for as long as four years.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> By contrast, skin metastasis can occur as an initial manifestation.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It was reported that the positive percentage of calretinin expression in malignant pleural mesothelioma was various (50%–100%), depending on the type of calretinin antibody.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The diagnosis of malignant mesothelioma is often challenging, especially in cases of calretinin negative staining. In the present case, the patient’s working history of asbestosis exposure and differentiation from pulmonary adenocarcinoma led to the diagnosis of malignant mesothelioma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Tatsuhiko Mori: Designed the study; performed the research and contributed to analysis and interpretation of data; wrote the initial draft of the manuscript; approved the final version of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto: Designed the study; assisted in the preparation of the manuscript; approved the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-28" "fechaAceptado" => "2020-07-23" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Mori T, Yamamoto T. Skin metastasis of malignant mesothelioma. An Bras Dermatol. 2021;96:642–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Dermatology, Fukushima Medical University, Fukushima, Japan.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1136 "Ancho" => 1508 "Tamanyo" => 402528 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological features show neoplastic monomorphous atypical cells, with eosinophilic or vacuolated cytoplasm proliferation in a solid pattern (Hematoxylin & eosin, ×400).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 682 "Ancho" => 905 "Tamanyo" => 211271 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Strong immunopositivity for vimentin (Vimentin, ×400).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 638 "Ancho" => 1505 "Tamanyo" => 157064 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epithelioid malignant mesothelioma metastatic to the skin: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.E. 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Ordóñez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-200308000-00001" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2003" "volumen" => "27" "paginaInicial" => "1031" "paginaFinal" => "1051" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12883236" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009600000005/v4_202110020832/S036505962100163X/v4_202110020832/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009600000005/v4_202110020832/S036505962100163X/v4_202110020832/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962100163X?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 85 | 77 | 162 |
| 2024 September | 128 | 83 | 211 |
| 2024 August | 143 | 126 | 269 |
| 2024 July | 133 | 93 | 226 |
| 2024 June | 96 | 180 | 276 |
| 2024 May | 73 | 68 | 141 |
| 2024 April | 91 | 82 | 173 |
| 2024 March | 82 | 69 | 151 |
| 2024 February | 96 | 77 | 173 |
| 2024 January | 70 | 39 | 109 |
| 2023 December | 56 | 67 | 123 |
| 2023 November | 68 | 76 | 144 |
| 2023 October | 54 | 82 | 136 |
| 2023 September | 68 | 68 | 136 |
| 2023 August | 48 | 26 | 74 |
| 2023 July | 66 | 45 | 111 |
| 2023 June | 49 | 39 | 88 |
| 2023 May | 37 | 22 | 59 |
| 2023 April | 36 | 17 | 53 |
| 2023 March | 60 | 55 | 115 |
| 2023 February | 36 | 35 | 71 |
| 2023 January | 36 | 34 | 70 |
| 2022 December | 43 | 33 | 76 |
| 2022 November | 49 | 70 | 119 |
| 2022 October | 109 | 59 | 168 |
| 2022 September | 56 | 71 | 127 |
| 2022 August | 39 | 45 | 84 |
| 2022 July | 41 | 58 | 99 |
| 2022 June | 44 | 60 | 104 |
| 2022 May | 37 | 47 | 84 |
| 2022 April | 67 | 59 | 126 |
| 2022 March | 56 | 66 | 122 |
| 2022 February | 27 | 46 | 73 |
| 2022 January | 76 | 66 | 142 |
| 2021 December | 73 | 62 | 135 |
| 2021 November | 51 | 64 | 115 |
| 2021 October | 101 | 97 | 198 |
| 2021 September | 117 | 86 | 203 |
| 2021 August | 52 | 85 | 137 |
| 2021 July | 4 | 6 | 10 |
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