Cutaneous lymphangitis carcinomatosa in salivary duct carcinoma

• Published in: Journal of clinical pathology Vol. 76; no. 3; pp. 211 - 213
• Main Authors: Uijen, Maike JM, Weijers, Jetty AM, Lassche, Gerben, van Ravensteijn, Stefan G, van Rijk, Maartje C, Lubeek, Satish FK, van Engen-van Grunsven, Adriana CH, Amir, Avital, Driessen, Chantal ML, van Herpen, Carla ML
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.03.2023; BMJ Publishing Group LTD
• Subjects: Androgens; Biopsy; Cancer therapies; Carcinoma; Chemotherapy; Cytokeratin; Dermatitis; Edema; Exocrine glands; Head and Neck Neoplasms; Humans; Lung Neoplasms; LYMPH NODES; Lymphangitis - diagnosis; Lymphangitis - etiology; Lymphangitis - pathology; Lymphatic system; Metastasis; Neck; Pathology; Patients; PostScript; Radiation therapy; Salivary Ducts - pathology; Salivary Glands; Surgery; Salivary Glands; LYMPH NODES; Head and Neck Neoplasms
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp-2022-208564

In our tertiary referral centre, 11 SDC patients developed skin lesions in the neck and chest region. Furthermore, we report on the molecular analysis of these 11 patients (online supplemental table 1).Table 1 Patient characteristics of SDC patients at time of diagnosis of CLC Patient No Age at diagnosis†† Sex Primary tumour N-stage* Number of LN metastases/ total of removed LNs Prior treatments Year of onset of CLC Location of CLC CLC diagnosed based on Complaints due to CLC Sites of metastases 1† 60–65 M Parotid gland N3b 25/31 Surgery, RT‡, palliative ADT Year 1 Neck and Chest region Clinical presentation, Imaging, Pathology Neck stiffness, movement restriction Lymph nodes 2§ 60–65 M Submandibular gland N2c 6¶ RT, palliative ADT Year 1 Neck and Chest region Clinical presentation, Imaging, Pathology Mechanical skin tension, movement restriction Lymph nodes, muscle, Bone 3 50–55 M Submandibular gland N3b 6¶ RT Year 1 Head and Neck region Clinical presentation, Imaging, Pathology – Lymph nodes 4 60–65 M Parotid gland N3b NR – Year 1 Neck and Chest region Pathology** Pain, ulceration Lymph nodes 5 50–55 F Parotid gland N2b 41/45 Surgery, RT, adjuvant ADT, chemotherapy Year 4 Head and Neck region Clinical presentation, Imaging, Pathology Oedema Lymph nodes, Bone, Liver 6 75–80 F Parotid gland N3b 45/61 Surgery, RT, adjuvant ADT Year 1 Head and Neck region Clinical presentation, Pathology Pain – 7 75–80 F Parotid gland N2b NR RT, palliative ADT Year 4 Axilla Clinical presentation, Pathology Pain Lymph nodes 8 70–75 M Parotid gland N2b 8/9 Surgery, RT, palliative ADT Year 4 Neck and Chest region Clinical presentation, Pathology Itchiness Lymph nodes, Lung 9 65–70 M Parotid gland N2b 22/27 Surgery, RT Year 1 Neck and Chest region Clinical presentation, Imaging, Pathology Mechanical skin tension Lymph nodes 10 75–80 M Unknown primary N3b NR¶ – Year 1 Neck and Chest region Clinical presentation, Imaging, Pathology – Lymph nodes, Bone, Lung 11 75–80 F Parotid gland N3b 6/35 Surgery, RT Year 2 Neck and Chest region Clinical presentation, Imaging, Pathology Itchiness Lymph nodes, Bone, Liver *Presence and extent of regional lymph node metastases, according to the TNM classification of malignant tumours eighth edition. †This is the patient presented in the manuscript as case 1. ‡Because axillary lymph node metastases were diagnosed shortly after the start of postoperative radiotherapy, this patient discontinued radiotherapy after 1 week. §This is the patient presented in the manuscript as case 2. ¶In these patients a lymph node neck dissection was not performed, if applicable the number of positive lymph nodes is based on imaging in combination with lymph node biopsies. **The primary diagnosis was unknown at time of pathology assessment, the CLC was the first clinical sign of his SDC disease. ††In order to optimise anonymisation, instead of the age of each patient, age ranges are presented. (B) Pathological evaluation of the skin biopsy revealed tumour cells within the lumina of dermal lymphatic vessels and infiltration into the dermis and hypodermis (D2-40 staining ×330, staining for lymphatic vessels; pan-cytokeratin staining CK AE 1/3 (red) + D2-40 [brown] staining ×330). Due to disease progression, CAB was discontinued, and second-line systemic therapy was initiated (paclitaxel and carboplatin). Due to this disease progression, CAB was discontinued and chemotherapy (paclitaxel and carboplatin) was initiated.