PMC6047099_01
Skin metastasis. Skin of the head (A, B). Left external acoustic meatus (C)
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A 72-year-old female patient, diagnosed with Binswanger's disease, with a history of tuberculosis, after surgery due to a compression fracture of the L1 vertebra was admitted to a dermatology ward because of skin lesions - violaceous noduleslocalised on the hair-covered skin of the head, in the left external acoustic meatus, on the back, and in the left groin (Figure 1).
Disseminated malignancy with a probable origin in the pancreas. Contrast-enhanced computed tomography in the arterial phase shows a soft tissue mass with rib destruction (A), an enhancing mass in the right breast (B), bilateral adrenal metastases (C), multiple osteolytic metastases (D),and pancreatic head tumour (E)
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Suspected metastatic lesions were found in the right breast (Figure 2).
Histopathological examination, H and E. Cells are small, round, with the same appearance and rim of narrow cytoplasm. Round nuclei, "salt pepper" chromatin appearance with numerous nucleoli. Several cell division figures, including pathological mitosis. x40 (A). x100 (B). Immunohistochemistry x200. CK Pan + (C). Synaptophysin + (D)
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Histopathology of the skin nodules confirmed a neuroendocrine tumour (Figure 3A and 3B). Metastases of a pancreatic neuroendocrine tumour or small-cell lung cancer were suspected based on a positive cytokeratin reaction (CK Pan+, CK18+, CK19+, synaptophysin+) on immunohistochemistry (Figure 3C and 3D).