Gastrointestinal: Zosteriform metastases to the skin
Gastrointestinal: Zosteriform metastases to the skin
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胃肠道：带状疱疹样转移至皮肤
DOI：
10.1111/j.1440-1746.2006.04345.x
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发表时间：
2006
影响因子：
4.1
通讯作者：
N. Egawa
中科院分区：
文献类型：
--
作者：
T. Kamisawa;M. Takahashi;H. Nakajima;N. Egawa
从胃肠道癌症发展到皮肤转移是罕见的。一种表现是出现在脐内或脐周围的恶性结节（玛丽约瑟夫修女结节）。这通常反映了广泛的腹部恶性肿瘤，如胃癌、胰腺癌或大肠癌。另一种表现是恶性皮肤结节，沿着诊断性细针穿刺或治疗性经皮引流所形成的束发展。图1和图2显示了另一种表现形式。患者为男性，84岁，左下胸出现水疱疹。四年前，由于胆囊癌累及局部淋巴结，他接受了根治性胆囊切除术。在出现皮疹之前，他被诊断为肺部和左腋窝淋巴结转移，并已开始化疗。关于皮疹，最初的诊断是带状疱疹，但用阿昔洛韦治疗无效。随后的皮肤活检显示转移性腺癌已扩散到真皮淋巴管，其外观与切除的胆囊相似。化疗继续进行，但患者在出现皮疹4个月后死亡。皮肤上类似带状疱疹的转移被称为带状疱疹样转移。在这个病例中，皮疹似乎累及左胸T6至T8皮节。然而，转移通过肋间神经扩散是极不可能的。最可能的解释是腋窝和左胸淋巴管肿瘤引起的广泛淋巴阻塞。这可能导致淋巴逆行流动，将肿瘤扩散到皮肤等部位。尽管恶性疾病患者发生带状疱疹的风险较高，但需要牢记带状疱疹样转移的可能性，特别是在抗病毒治疗未能改善的人群中。
It is rare to develop skin metastases from gastrointestinal cancer. One manifestation is that of a malignant nodule that develops in or around the umbilicus (Sister Mary Joseph nodule). This usually reflects widespread intra-abdominal malignancy from cancer of the stomach, pancreas or large bowel. Another manifestation is a malignant skin nodule that develop along tracts created by diagnostic fine-needle aspiration or therapeutic percutaneous drains for malignant biliary disease. Yet another manifestation is shown in Figs 1 and 2. The patient was a man, aged 84, who presented with a vesicular rash on his left lower chest. Four years previously, he had undergone a radical cholecystectomy because of gallbladder cancer involving regional lymph nodes. Prior to the development of the rash, he had been diagnosed with metastases in the lung and left axillary lymph nodes and had been started on chemotherapy. In relation to the rash, the initial diagnosis was that of Herpes zoster but treatment with aciclovir was ineffective. A subsequent skin biopsy revealed metastatic adenocarcinoma with spread to dermal lymphatics that had a similar appearance to that of the resected gallbladder. Chemotherapy was continued but the patient died 4 months after the development of the skin rash. Metastases in the skin that resemble Herpes zoster have been called zosteriform metastases. In this case, the rash appeared to involve the left thoracic dermatomes, T6 to T8. However, it is highly unlikely that metastases developed by spread through intercostal nerves. The most likely explanation is widespread lymphatic obstruction by tumor in lymph vessels in the axilla and left chest. This can result in retrograde lymph flow that spreads the tumor into sites such as the skin. Although patients with malignant disease are at higher risk of Herpes zoster, the possibility of zosteriform metastases needs to be kept in mind, particularly in the group who fail to improve with antiviral therapy.