Carcinoma Erysipeloides From Metastatic Cutaneous Squamous Cell Carcinoma Initially Mistaken for Intralymphatic Histiocytosis

Abstract

Intralymphatic histiocytosis is a rare dermatologic disorder, commonly associated with inflammatory disorders and rarely malignancy. Carcinoma erysipeloides (CE) is a rare pseudoinflammatory cutaneous eruption that resembles soft -tissue infections as result of intralymphatic metastasis and subsequent lymphatic obstruction. Breast carcinoma represents most of the CE cases, but rarely other malignancies are involved. This report discusses a patient with a history of cutaneous squamous cell carcinoma (SCC) of the temple, who was initially diagnosed with intralymphatic histiocytosis located on his upper extremity, resistant to treatment. Further dermatologic and pathologic review later revealed metastatic SCC restricted to the dermal lymphatics, creating a CE reaction, initially obscured by intralymphatic histiocytes. This case highlights the difficulty in diagnosing metastatic carcinoma when the malignant cells are accompanied by a dense histiocytic infiltrate. The case demonstrates a rare presentation of CE due to metastatic cutaneous SCC and highlights the need for persistent investigation when confronted with nonconforming pathology.

Intralymphatic histiocytosis in healing cellulitis: Case report and review of the literature

“…The histopathologic differential diagnosis for ILH includes intravascular carcinomatosis, reactive angioendotheliomatosis, intravascular lymphoma, and leukemia 2,3,5,6,49 . Reactive angioendotheliomatosis is a rare and poorly defined disorder characterized by intravascular proliferation of cells expressing endothelial cell markers.…”

The role of micrometastasis in high‐risk skin cancers

“…lymphatics are gaining recognition as active branches that promote forward cancer cell development and distal metastasis. 8,[38][39][40] Before the last two decades, there was a focus on the biological importance of angiogenesis in cancer progression with relatively little attention paid to tumour lymphangiogenesis. 9,41 This has now changed with recent research examining the role of lymphatic pathways in cancer metastasis.…”

“…Cancer cells are not simply passengers in lymph flow, but rather, have complex interactions within the lymph node microenvironment leading to enhancement of their metastatic capabilities 8,9,38,39 . Loco‐regional lymphatics are gaining recognition as active branches that promote forward cancer cell development and distal metastasis 8,38–40 . Before the last two decades, there was a focus on the biological importance of angiogenesis in cancer progression with relatively little attention paid to tumour lymphangiogenesis 9,41 .…”

“…For skin, these include all intradermal or subdermal metastasis between the primary scar and the tumour‐draining nodal basin 26,61–63 . Macrometastatic ITM present as papulo‐nodules and are described for SCC, 40,62,64 MCC 26,27 and melanoma 58,61,65–68 . As external assay techniques improve in sensitivity, it is expected that smaller mass cancer cell clusters will be identified in lymphatic channels 58 .…”