Metastatic gastric signet ring cell carcinoma clinically mimicking radiation recall dermatitis

Abstract

A 53-year-old woman presented to the dermatology clinic with a history of a bilateral circular orange discoloration around the upper and lower eyelids. On physical examination, the orange flat plaque lesions involved both the upper and lower eyelids, resembling a pair of circles. The lesions of the medial side of both of the upper eyelids were particularly large (Fig. 1a,b). There was orange discoloration of the palms (Fig. 1c) and soles. The sclerae and oral mucosa appeared normal. She had no organomegaly. We learned that the patient ate too much carrot and orange over the last two months, which underlined her anamnesis. In the light of the clinical exam and anamnesis, the patient was diagnosed xanthelasmas and carotenoderma. Laboratory tests were evaluated, and the total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were 258 mg/dl (range 50-200 mg/dl), 35.2 mg/dl (range 35-55 mg/dl), and 137 mg/dl (0-150 mg/dl). Respectively, the total cholesterol level was in the higher than normal range.Xanthelasma is the most common type of cutaneous xanthoma. They may indicate hyperlipidemia, but 25-70% of patients in most cases are normolipidemic. Histologically, foamy histiocytes occur in the perivascular area, mostly in the middle and superficial layers of the dermis. They contain membrane-bound lipid vacuoles, cholesterol crystals, lysosomes, and residual bodies. 1 Carotenoderma is a phenomenon characterized by orange pigmentation of the skin, resulting from carotene deposition mainly in the stratum corneum, in sweat and in sebum, such as the nasolabial folds, palms, and soles. The sclerae are not affected, and this helps to distinguish carotenoderma from jaundice. 2 Both diseases are distinct clinical manifestations. Carotene exclusively accumulates in the regions such as thick stratum corneum, where the proportion of sebum is high. 2 In this case, the orange ring occurred due to the accumulation of carotene in xanthelasma lesions, where the amount of lipid is rather high.

A Case of Cutaneous Metastases of Salivary Duct Carcinoma Mimicking Radiation Recall Dermatitis

“…There is only one case similar to our case in the English literature. In the case of Kim et al 4 , the patient presented with erythematous edematous plaques on the previous radiation site and had started on oral chemotherapy with capecitabine three weeks ago. So they had a impression of radiation recall dermatitis, but metastatic gastric signet ring cell carcinoma was diagnosed after the biopsy specimen was obtained 4 .…”