Cutaneous Metastatic Cancer: Carcinoma Hemorrhagiectoides Presenting as the Shield Sign

Cohen, Philip R.; Kurzrock, Razelle

doi:10.7759/cureus.12627

Cited by 3 publications

(16 citation statements)

References 15 publications

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“…Clinically, cutaneous tumor lysis syndrome presents as ulcers (which have also been described as tumor necrosis) within the tumor mass. A critical criteria for cutaneous tumor lysis syndrome is the presence of rapid tumor cell death [3][4][5]7,.…”

Section: Cutaneous Tumor Lysis Syndromementioning

confidence: 99%

“…Features suggestive of this syndrome have been observed in oncology patients with hematologic malignancies such as lymphomas. Cancer patients whose solid tumors have characteristics compatible with therapy-associated cutaneous tumor lysis syndrome include individuals with Kaposi sarcoma, women with metastatic breast cancer, and our patient with metastatic salivary duct carcinoma [3][4][5]27,[40][41][42][43][44][45][46][47][48][49][50].…”

Section: Therapy-associated Cutaneous Tumor Lysis Syndromementioning

confidence: 99%

“…Our patient with metastatic salivary duct carcinoma developed rapid death of his tumor cells, manifesting clinically as necrosis and ulcers at the location of his skin metastases, within days after his first infusion of bevacizumab and temsirolimus. Because he had phosphatase and tensin homolog (PTEN) loss [resulting in activation of the phosphatidylinositol 3-kinase (PI3K) pathway, which is targeted by mechanistic target of rapamycin (mTOR) inhibitors such as temsirolimus], we postulate that temsirolimus alone or in synergy with bevacizumab resulted in his dramatic response to treatment [3][4][5].…”

Section: Therapy-associated Cutaneous Tumor Lysis Syndromementioning

confidence: 99%

“…Therapy-associated cutaneous tumor lysis syndrome has also been observed in breast cancer patients with extensive skin metastases after initiation of combination therapy which included bevacizumab; the phenomenon was described as either skin necrosis or tumor necrosis or large ulcer expansion, and it occurred shortly after the first cycle of treatment with bevacizumab-based therapy ( Table 8) [47][48][49]. In addition, we observed therapy-associated cutaneous tumor lysis syndrome in a man whose metastatic salivary duct carcinoma demonstrated rapid cell death and presented as necrosis and ulcers within days after receiving his initial cycle of dual-agent (bevacizumab and temsirolimus) antineoplastic therapy [3][4][5]. A retrospective study described 12 women with advanced infiltrating ductal breast carcinoma who had extensive cutaneous metastases and were treated with antineoplastic therapy that included bevacizumab.…”

Section: Mycosis Fungoidesmentioning

confidence: 99%

“…We previously observed that the cancer-associated skin lesions in a man with aggressive cutaneous metastatic salivary duct carcinoma developed into ulcers, associated with rapid tumor regression, after one cycle of antineoplastic therapy. We suggest that this clinical phenomenon be referred to as cutaneous tumor lysis syndrome [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System

Cohen¹,

Prieto

Kurzrock

2021

Cureus

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Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, as well as renal injury with an elevated creatinine. Tumor lysis syndrome is seen in patients with aggressive malignancies and high tumor burden. More frequently, it occurs in individuals with hematologic malignancies such as high-grade lymphomas (such as Burkitt lymphoma) and leukemia (such as acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid tumors that are rapidly proliferating and are markedly sensitivity to antineoplastic therapy. Tumor lysis syndrome is usually preceded by cancer-directed therapy; however, the syndrome can present spontaneously prior to the individual receiving malignancydirected treatment. We reported a man with metastatic salivary duct carcinoma who had cutaneous metastases that presented as carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of antineoplastic therapy, he had an excellent response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. His dramatic response to treatment prompted us to propose a new classification of tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous tumor lysis syndrome. We anticipate that, with improvement in targeted therapies, there may be an increase in therapyassociated cutaneous tumor lysis syndrome.

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Section: Cutaneous Tumor Lysis Syndromementioning

confidence: 99%