Opportunistic metastatic porocarcinoma after saphenous venectomy for coronary bypass surgery

Abstract

Immunocompromised areas of the skin, caused by chronic lymphoedema, paraplegia, infections or traumas, represent a site of regional neuroimmunocutaneous destabilization, termed the immunocompromised cutaneous district (ICD), in which malignancies and other opportunistic disorders are more likely to occur. We report the case of a metastatic porocarcinoma (PC) occurring on a lymphoedematous limb in a 72-year-old man. We reviewed the literature to better understand the potential pathogenetic mechanisms behind this condition. It has been reported that removal of the leg vein destroys the medial group of the superficial lymphatic vessels and alters the normal lymph drainage of the leg, predisposing to recurrent cellulitis. Our observations suggest that saphenous venectomy can induce development of an ICD. We suggest that PC, a rare cutaneous tumour, should be included in the growing list of tumours arising in the ICD.

Porocarcinoma; presentation and management, a meta-analysis of 453 cases

“…The mean age of presentation is seventh and eighth decades of life (mean age 67.57 years, ranging from 7 months to 97 years) [34]. Most of the patients present with mass without symptoms (poroma) long time before converting to malignant type (porocarcinoma) [8], [62]. According to this study, the mean duration of presentation was 5.73 years.…”

“…In the literature, several histological features and subtype mentioned. These includes; ductal differentiation, nests of basaloid cells, squamoid tumor cells, infiltrative spinal cells, cells of acanthotic epidermis, Borst Judasson appearance, ulcerated epithelial tumor, bowenoid porocarcinoma, nests of small atypical cells, clear-cell, high infilterative pattern and hyperchromatic nuclear [7], [13], [26], [62], [72], [103], [102]. Surgery was the main mode of therapy with adjuvant chemoradiotherapy if metastasis and/or recurrence occurred [50], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102], [103], [104].…”

The immunocompromised district in dermatology: A unifying pathogenic view of the regional immune dysregulation

“…It is an umbrella term that encompasses all the listed definitions plus further conditions not included in any of the earlier definitions. 4,5,[40][41][42][43][44][45][46][47][48][49] References in the right column provide illustrative examples for each item (except for the general concepts of lmr and LMR). Importantly, in some instances, the authors of the reports, although describing their cases, did not give the specific or appropriate definition of the phenomenon; in other instances, they used a terminology different from the more homogenous one that we are proposing here (eg, Bernhard et al's "localized cutaneous photoanergy" 13 corresponds to our isophototopic nonresponse).…”

Facial flat warts at a completely healed site of trauma are not an example of Wolf's isotopic response

“…), tattooing, intradermal vaccination, and neurologic injuries (carpal tunnel syndrome, cerebral and cerebellar stroke, poliomyelitis, facial nerve palsy) . Whatever the cause, in time an ICD may become a vulnerable site, prone to developing opportunistic infections, tumors, or dysimmune reactions that are strictly confined to that cutaneous area . However, the opposite may also occur with systemic immune disorders or malignancies that selectively spare the area.…”