Carcinoma erysipelatoides from urinary bladder carcinoma
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chemical profile, with positivity for CK7, CK20 and GATA 3, confirmed the diagnosis of urothelial carcinoma cells (figure 1D). Thus, diagnosis of carcinoma erysipelatoides was established. The patient was referred to the department of oncology and therapy with pembrolizumab was initiated. Despite this treatment, the patient died three months later from visceral metastatic spread. Cutaneous metastases from internal malignancies are uncommon. The incidence of cutaneous involvement by all urological malignancies is estimated at 1.1% to 2.5%. The most common source is the kidney [1]. Urinary bladder cancers are less likely to metastasize to the skin [2]. The most common clinical presentation of cutaneous metastasis is a firm, painless skin-coloured to pink-red nodule or plaque. The lesion may arise in the vicinity of the primary cancer. Thus, cutaneous metastases from bladder carcinoma are often found on the abdominal skin. Carcinoma erysipelatoides (also called “cutaneous carcinomatous lymphangitis” or “inflammatory carcinoma”) is a rare form of cutaneous metastasis. It is due to spread of tumour cells within the dermal lymphatic vessels [3]. The clinical presentation is an erythematous patch with spreading border, resembling erysipelas. This leads to the term “carcinoma erysipelatoides”. Thus, it may initially be misdiagnosed as erysipelas. Extensive malignant obstruction of the lymphatics can induce secondary lymphedema, as observed on the lower extremities of our patient. Carcinoma erysipelatoides most often occurs in breast cancer [3]. It has also been reported in other malignancies, such as lung, nasopharyngeal, thyroid, stomach, colon and prostatic cancer [4]. In general, the prognosis is poor. Carcinoma erysipelatoides from urothelial bladder carcinoma is very rare, as only a few cases have been reported in the literature so far
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Figure 1. A) Pitting oedema and erythema on the lower extremities and abdomen. B) Erysipelas-like and cobblestone appearance of the abdominal skin. C) Atypical cells within dermal lymphatic vessels. D) Cells stain positive for CK7.
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EJD, vol. 30, n◦ 4, July-August 2020
[5]. In one patient, the initial presentation was lymphedema of the right leg and suprapubic area and the bladder carcinoma was only diagnosed subsequently [6]. In cases of previous lymphadenectomy in the context of carcinoma, differential diagnosis includes postsurgical lymphedema, acute inflammatory attacks with lymph stasis (non-febrile pseudo erysipelas) and true erysipelas. Our patient had urothelial bladder carcinoma and was considered to be in remission as skin changes appeared. We observed both lymhadenomatous skin changes and erysipelas-like erythema. Our case underlines the importance of early biopsy in order to prevent misdiagnosis or delayed diagnosis. Disclosures. Financial disclosure: none. Conflicts of interest: none. Municipal Hospital Hietzing, Dermatology Department, Wolkersbergenstraße 1, 1130 Vienna, Austria
Robert FELDMANN Marlies WRUHS Alexander STELLA Andreas STEINER
1. Ohlsson R,
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