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Year : 2021  |  Volume : 36  |  Issue : 1  |  Page : 82-84  

Paraneoplastic cutaneous mucinosis as initial presentation of recurrence in an operated case of carcinoma ovary: True extent of recurrent metastatic disease unveiled on 18F fluoro-d-glucose positron emission tomography-computed tomography


1 Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission21-Apr-2020
Date of Decision11-May-2020
Date of Acceptance17-Jul-2020
Date of Web Publication04-Mar-2021

Correspondence Address:
Dr. Shamim Ahmed Shamim
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_77_20

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   Abstract 


Ovarian carcinoma is associated with many cutaneous and paraneoplastic manifestations. We present a case of 52-year-old female who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for epithelial origin ovarian carcinoma. She presented with skin rashes over the face and neck region after 2 years. 18F-fluoro-D-glucose positron emission tomography-computed tomography scan revealed recurrent metastatic retroperitoneal lymph nodes.

Keywords: Carcinoma, fluoro-D-glucose, mucinosis, ovary, paraneoplastic


How to cite this article:
Tripathy S, Arava S, Arun Raj ST, Prakash S, Pathak N, Marachapu J, Shamim SA. Paraneoplastic cutaneous mucinosis as initial presentation of recurrence in an operated case of carcinoma ovary: True extent of recurrent metastatic disease unveiled on 18F fluoro-d-glucose positron emission tomography-computed tomography. Indian J Nucl Med 2021;36:82-4

How to cite this URL:
Tripathy S, Arava S, Arun Raj ST, Prakash S, Pathak N, Marachapu J, Shamim SA. Paraneoplastic cutaneous mucinosis as initial presentation of recurrence in an operated case of carcinoma ovary: True extent of recurrent metastatic disease unveiled on 18F fluoro-d-glucose positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2021 [cited 2021 Apr 21];36:82-4. Available from: https://www.ijnm.in/text.asp?2021/36/1/82/310800



A 52-year-old female underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with adjuvant chemotherapy for epithelial origin ovarian carcinoma. She presented with skin rashes to the dermatology outpatient department after 2 years [Figure 1]a and [Figure 1]b. These skin rashes were new features and were not present at the onset of disease manifestations. Histopathology examination of the cutaneous thickening over the nasal region revealed mild irregular acanthosis with perivascular chronic inflammation in the upper dermis [Figure 2]a, arrow], with the presence of moderate amount of extracellular dermal mucin [Figure 2]b. Suspecting paraneoplastic cutaneous manifestation in the backdrop of history of ovarian malignancy, 18F-fluoro-D-glucose positron emission tomography-computed tomography (FDG PET-CT) was advised for the evaluation of actual extent of the underlying metastatic disease, if any. 18F-FDG PET-CT scan revealed few enlarged FDG avid lymph nodes in the left para-aortic region, largest measuring approximately 2.4 cm × 1.8 cm [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e with increased FDG uptake in the cutaneous region overlying the nasal region [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d, [Figure 4]e, [Figure 4]f. Biopsy from the left para-aortic lymph nodes was consistent with metastasis from epithelial origin ovarian carcinoma.
Figure 1: (a and b) Image of the patient showing erythematous skin rashes over the face and neck region

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Figure 2: (a) Microscopy of the skin biopsy (H and E stain) showing mild irregular acanthosis in epidermis with perivascular chronic inflammation in the upper dermis (arrow). (b) Special histochemical (Alcian blue periodic acid fuscin) stain showing the presence of moderate amount of extracellular dermal mucin

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Figure 3: (a) Maximum intensity projection image of the fluoro-D-glucose positron emission tomography-computed tomography showing focal areas of radiotracer uptake in the left side of the abdomen corresponding to enlarged lymph nodes in the left para-aortic region on axial section computed tomography image (b and d, arrow) showing increased fluoro-D-glucose uptake in the fused positron emission tomography-computed tomography image (c and e)

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Figure 4: (a) Axial computed tomography head region showing cutaneous thickening over the nasal region showing fluoro-D-glucose uptake in positron emission tomography only image (b) and fused positron emission tomography-computed tomography image (c). (d) Sagittal computed tomography head region showing cutaneous thickening over the nasal and chin region showing fluoro-D-glucose uptake in positron emission tomography only image (e) and fused positron emission tomography-computed tomography image (f)

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Ovarian malignancies are associated with multiple cutaneous paraneoplastic associations that include acanthosis nigricans, Raynaud's phenomenon, scleroderma, dermatomyositis, and palmar fasciitis with polyarthritis.[1],[2],[3],[4],[5],[6],[7] Paraneoplastic cutaneous mucinosis, although very rare, has been reported in the literature in association with pulmonary and hematologic malignancies.[8],[9] All stages of ovarian malignancies can produce cutaneous paraneoplastic manifestations. Although there is no clear evidence about why various malignancies produce cutaneous paraneoplastic manifestation, one hypothesis could be that it is not the cancer that directly effects changes in the skin but rather the immune system itself; it may be that the responses and function of the immune system are subtly altered by ovarian carcinoma or that the malfunctions of the immune system might precede ovarian carcinoma.[10] The authors through this case want to highlight this rare clinical manifestation of ovarian malignancy with no obvious abdominal symptoms, which can act as a template for accurate diagnosis of disease recurrence in a patient with history of ovarian malignancy in the future. Further, the authors through this case want to underscore the importance of18F-FDG PET-CT in accurate evaluation of disease extent in suspected cases of recurrence, pertaining to ovarian malignancies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
American Cancer Society. Cancer Facts and Figures 2005. Atlanta, GA: American Cancer Society; 2005.  Back to cited text no. 1
    
2.
Rabban JT, Bell DA. Current issues in the pathology of ovarian cancer. J Reprod Med 2005;50:467-74.  Back to cited text no. 2
    
3.
Sigurgeirsson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med 1992;326:363-7.  Back to cited text no. 3
    
4.
Miller FO, Newman ED. Dermatomyositis and polymyositis. In: Arndt KA, Leboit PE, Robinson JK, Wintroub BU, editors. Cutaneous Medicine and Surgery. Philadelphia: WB Saunders; 1996. p. 283-90.  Back to cited text no. 4
    
5.
Davis MD, Ahmed I. Ovarian malignancy in patients with dermatomyositis and polymyositis: A retrospective analysis of fourteen cases. J Am Acad Dermatol 1997;37:730-3.  Back to cited text no. 5
    
6.
Callen JP. Dermatomyositis and female malignancy. J Surg Oncol 1986;32:121-4.  Back to cited text no. 6
    
7.
Hashimoto M, Yoshifuji H, Mimori T. A case of dermatomyositis associated with different types of cancers at intervals of six years. Nihon Rinsho Meneki Gakkai Kaishi 2004;27:427-30.  Back to cited text no. 7
    
8.
Yao C, Choksi AN, McLain PM. Paraneoplastic plaque-like cutaneous mucinosis in a patient with lung adenocarcinoma. J Cutan Pathol 2018;45:305-7.  Back to cited text no. 8
    
9.
Geller S, Gomez CJ, Myskowski PL, Pulitzer M. Follicular mucinosis in patients with hematologic malignancies other than mycosis fungoides: A clinicopathologic study. J Am Acad Dermatol 2019;80:1704-11.  Back to cited text no. 9
    
10.
Scheinfeld N. A review of the cutaneous paraneoplastic associations and metastatic presentations of ovarian carcinoma. Clin Exp Dermatol 2008;33:10-5.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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