Disseminated cutaneous and eyelid metastases from a carcinoma of the breast.

With several diagnostic methods, i.e. ultrasonography of the breast Sir, and visceral organs, mammography and subsequent cytological examCutaneous metastases in carcinoma of the breast usually arise ination, CT of the lungs, skeletal scintigraphy, a diagnosis was made; from haematogenous or lymphatic dissemination; occasionally primary right breast adenocarcinoma with metastases on the skin, as they will arise from direct extension of an underlying tumour well as in the lymph nodes, lungs, pleura and bones (mainly in the or even by iatrogenic seeding from a tumour. In this article, ribs). Biochemical scrutiny (RIA method with I125) revealed high we report an unusual case of miliary breast carcinoma tumour marker levels; CA549 (CIS) – 179.2 U/ml (normal levels dissemination. 12.1 U/ml ), CA72–4 (CIS) – 50.7 U/ml (normal level to 4 U/ml ), CA15–3 (CIS) – 135.1 U/ml (normal to 28 U/ml ), the AFP (Immunotech) 1.9 ng/ml (normal level 2–10 ng/ml ), the TPS (BEKI ) CASE REPORT – 1130.8 U/l (normal level 0–80 U/l ); the CEA (Immunotech) was A 63-year-old multiparous female patient (three children) was observed more than 400 ng/ml (normal level 4 ng/ml ). for 6 months; several hundred partly confluent elastic, non-ulcerating After the introduction of tamoxifen therapy – 10 mg twice daily – infiltrated and slightly inflamed oval papules and nodules (1–30 mm the patient was referred to the Oncological Centre for further treatment in diameter) developed and disseminated. For the most part, they and observation. were painless and localized primarily on the back, dorsal neck and forehead; some had extended to the scalp, causing alopecia neoplastica in the occipital region. Lesions were also located on the upper DISCUSSION extremities, on the gluteal region and on the thighs. According to the literature (1) prior to 1990 breast carcinoma Within the left eyelid, a hard flat tumour infiltrate developed, skin metastases fall into three groups; metastases developing extending to the retrobulbar space and causing movement restriction via the lymphatic vessels, situated near; in the mastectomy scar as well as ptosis in the left eye (Fig. 1). In the neck flexor region, palpable lymph nodes formed aggregates site, metastases developing at a single site distant from the prevailing on the right side. To check for malignancy, two biopsies primary breast cancer where there is a late presentation of the were taken from the skin metastases found on the neck, back of the primary breast cancer and finally miliary tumour dissemination. thorax, and from the right axilla lymph node. Distant breast cancer cutaneous metastases, like a single Histopathology revealed poorly differentiated anaplastic cells, with metastasis, are rare but do occur, most often secondary to the marked nucleolus, eosinophilic cytoplasm and expressive fibrous haematogenous dissemination (2). desmoplastic corium reaction. Most of the isolated tumour elements In the case reported here, it is difficult to say where the first were without organic structures or solid formations. Tumour cells skin metastases developed. According to the patient it took invading the dermis and subcutis showed diffuse infiltration of the place nearly 6 months before the initial medical investigation. dermal collagen, sometimes also as a perivascular arrangement of Skin metastases were apparent to the patient before primary tumour elements. The tumour cells immunohistochemically expressed positivity of tumour recognition. A metastasizing process in the eyelid is S-100 protein (polyclonal antibody anti – S protein; Biogenex), extremely rare as an initial tumour symptom (3, 4). estrogen receptors – ER (ER – related protein p29; Biogenex), PC 10 (monoclonal antibody, proliferating cell nuclear antigen; Biogenex), REFERENCES positivity of KL1 (cytokeratin filaments; Immunotech) and positivity of CEA (carcinoembryonic antigen, polyclonal antibody; Biogenex). 1. Baldari U, Zanelli R, Foschi R, Ridolfi R. Cutaneous metastases Lymph node histology confirmed metastasis breast carcinoma from breast carcinoma: a report of 18 cases. Clin Exp Dermatol through the cytokeratin intermediary filaments. Metastasis showed a 1992; 17: 321–323. segregated picture of dispersed cells with fibroproduction, intrasinus 2. Peled IJ, Okon E, Wescher Z, Wexler MR. Distant late metastases propagation, perifollicular metastasis growth in the lymph node and to skin of carcinoma of the breast. J Dermatol Surg Oncol 1982; germinative centre residual lymphatic follicle damage. 8: 192–195. 3. Zhang GJ, Adachi I, Yin DF, Narabayashi M, Tokue Y, Watanabe Y, et al. Eyelid metastasis from breast cancer showing marker response to chemotherapy. Jpn J Clin Oncol 1995; 25(1): 10–15. 4. Chirino CN, Genini LJ, Lynch PJ. Cutaneous metastases of breast adenocarcinoma located in the eyelids. Revista Argentina Dermatol 1985; 66: 286–290.