skin metastases from lung cancer
Introduction
Introduction to lung cancer skin metastasis Skin metastases from lung cancer (lungcarcinoma) account for 12% to 24% of male skin metastases and 2% to 4% of women. Start to be flesh-colored and quickly grow to a certain size and remain still. In metastatic lung cancer, adenocarcinoma accounts for 30%, squamous cell carcinoma accounts for 30%, and large tumor centers have necrotic areas. basic knowledge The proportion of illness: the incidence rate is about 0.004%-0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: hemangioma
Cause
Lung cancer skin metastasis
The main cause of skin metastasis in lung cancer is the absence of timely detection and treatment of primary lung cancer, resulting in skin metastasis.
Prevention
Lung cancer skin metastasis prevention
1. Once lung cancer is discovered, active treatment is still necessary. Regularly check and pay attention to changes in the skin.
2. Strengthen anti-cancer education and regular screening of high-risk groups for occupational poisoning to avoid long-term exposure to coal tar substances, arsenic agents and chemical carcinogens. Occupational contacts should pay attention to strengthening protection during work to prevent skin cancer.
3. Active treatment and regular examination of chronic ulcers, chronic inflammation and leukoplakia that cannot be cured for a long time can help prevent skin cancer.
Complication
Lung cancer skin metastasis complications Complications
The skin metastasis of lung cancer develops rapidly and is highly destructive. It can penetrate into connective tissue, cartilage, periosteum and bone, and abnormalities in the corresponding parts can occur. Regional lymph node metastasis can often occur, and visceral metastasis can occur in the late stage.
Symptom
Lung cancer skin metastasis symptoms Common symptoms No sweat gland ductal keratin... Inflammatory cell infiltration chest radiograph shows isolated nodule nodules in the lung
Lesions are usually non-tactile localized clusters or loose solid nodules, beginning to be flesh-colored, rapidly growing to a certain size, remain static, and some cases are vascular, similar to hemangioma, suppurative granuloma or Kaposi sarcoma.
Examine
Examination of lung cancer skin metastasis
Histopathology: Adenocarcinoma accounts for 30% of metastatic lung cancer, squamous cell carcinoma accounts for 30%, and other undifferentiated carcinomas include large cell undifferentiated carcinoma and small (oat) cell undifferentiated carcinoma, bronchoalveolar mucinous epithelioid carcinoid and pulmonary sarcoma. Rarely, tumor cells derived from lung squamous cell metastasis, usually moderate or poorly differentiated, are epithelial-like islands with varying degrees of keratinization and intercellular bridges, usually with only a small number of squamous cell vortexes. (Angular beads), keratinocytes are atypical, showing large and grotesque cells, spindle cells, clear cells and a large number of mitotic figures, and the center of large tumors is necrotic.
Metastatic carcinomas derived from lung adenocarcinoma usually have moderate differentiation, tubular and glandular structures, tumor cells are pleomorphic, nuclear staining is deep, and there are many mitotic figures.
Large cell undifferentiated carcinoma metastatic carcinoma consists of flaky large and pleomorphic cells with abundant cytoplasm and obvious nucleoli. Many mitotic figures are seen. Giant cell subtypes have ghost cells, nuclear eccentrics and cells that phagocytose white blood cells. The cell subtype consists of flaky clear cells and clear cell islands.
Small cell undifferentiated lung metastasis consists of mild pleomorphic cells slightly larger than lymphocytes, which are arranged in islands, trabecular and rosette-like, with common mitotic figures.
Immunohistochemistry: derived from lung metastatic squamous cell carcinoma, like other squamous cell carcinomas, cytokeratin and epithelial membrane antigen are positive, 50% to 80% are derived from lung squamous cell metastasis, carcinoembryonic antigen is positive, From lung metastatic adenocarcinoma, positive for PAS staining and amylase resistant, mucin-positive, 70% to 100% carcinoembryonic antigen (CEA) positive, large cell undifferentiated metastatic carcinoma derived from lung, cytokeratin and carcinoembry Antigen-positive, neuron-specific enolase, S-100 protein and leukocyte common antigen-negative, low-molecular heavy cytokeratin from diffuse perinuclear granule-type positive reaction and neurotropic Filaments also showed positive responses to varying degrees, and were also positive for neuron specific enolase (NSE) and negative for S-100 protein.
Diagnosis
Diagnosis and differentiation of lung cancer skin metastasis
According to clinical manifestations, the characteristics of skin lesions and histopathological features can be diagnosed. The following points should be noted:
1. Clinically short-term (6 to 12 months) rapid growth of tumor nodules, distributed in the vicinity of the primary tumor surgery area or the corresponding lymphatic drainage area, and its histopathological morphology is similar to the primary tumor, especially When it is characterized by multiple or multifocal tumors, it should be considered as metastatic cancer of the skin.
2. Tumor plugs are found in the skin or subcutaneous fat vessels or lymphatic vessels. The distribution configuration of the cancer is narrow and trapezoidal at the bottom, generally not connected with the epidermis, there is very little inflammatory cell infiltration around the tumor cells, and no sweat gland ductal keratin membrane Differentiation, etc., are often characteristic of metastatic skin tumors.
3. It is helpful to distinguish by means of immunohistochemical markers. For example, the tumor originated from the sweat gland-derived tumor is positive for GCDFP-15, while the tumors of the prostate and thyroid metastasized to the skin are positive for PSA and TG, respectively. In addition, metastatic skin in the umbilical cord Nodules must be excluded from endometriosis or implanted nodules, and should also be distinguished from yolk sac or urinary tract embryo residues.
In some cases, the appearance of vascularity should be differentiated from hemangiomas, pyogenic granulomas or Kaposi sarcomas.
