Case 398 -- Multiple cutaneous malignancies and related fatal outcome

Contributed by Beth Z Clark, MD, Drazen M Jukic, MD, PhD, and Leena T Lourduraj, MD
Published on line in August, 2004


The patient was a male in his seventies with a history of non insulin-dependent diabetes mellitus and hyperlipidemia. He developed hypertension at the age of his early fifties and was subsequently diagnosed with polycystic kidney disease. The patient's renal function progressively declined and he underwent cadaveric renal transplantation at the age of sixties. Immunosuppressive regimen included cyclosporine, azathioprine, and prednisone. Eight years post-transplant, the patient was diagnosed with squamous cell carcinoma in-situ of the skin of the right and left shoulders and overlying the trapezius muscle. Over the next two years, numerous squamous cell carcinomas developed on the patient's head and neck, upper extremities, chest, and back. Ten years post-transplant, the patient developed a nodular mass on his right forearm. Excision of this mass was performed and it was submitted for gross and microscopic examination. Hematoxylin and eosin stained slides and immunohistochemical stains

Residual neoplasm was identified on re-excision of the neoplasm, as well as squamous cell carcinoma in-situ (also of the left forearm).

Multifocal recurrences of the left ulnar and radial wrist with angiolymphatic involvement were discovered four months after initial diagnosis of this neoplasm. Bilateral axillary lymphadenopathy and a lesion of the right hepatic lobe were thought to represent metastases. The patient underwent chemotherapy with weekly paclitaxel.

Approximately 18 months later, the patient had multiple skin lesions over his entire body, concentrated on the abdomen. He had undergone palliative surgeries and his pain was controlled with narcotic analgesia. The patient died at home after a slow progressive decline. Post-mortem examination revealed extensive metastatic neoplasm, including numerous liver metastases, up to 7.5 cm, as well as multiple cutaneous, rib and bone marrow, mesenteric lymph nodal, diaphragmatic, pancreatic, and adrenal metastases.


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