Ann Dermatol.  2011 Sep;23(Suppl 1):S20-S24. 10.5021/ad.2011.23.S1.S20.

CK20 Positive Large-cell Neuroendocrine Carcinoma Presenting with Skin Metastases

• Shin MK
• Choi CM
• Oh YJ
• Kim NI

• KMID: 2156743
• DOI: http://doi.org/10.5021/ad.2011.23.S1.S20

Abstract

We present a case of cytokeratin (CK) 20-positive large cell neuroendocrine carcinoma (LCNEC) presenting with multiple skin metastases as the primary manifestation. The patient was a 55-year-old man who presented with a one- month history of subcutaneous skin colored nodules of various sizes on his trunk. Pathologic examination of the skin revealed a nested and solid proliferation of large undifferentiated cells with vesicular nuclei and prominent nucleoli. Tumor cells were found to be immunohistochemically positive for CK 20, chromogranin A, synaptophysin, and CD56. Based on these features, the tumor was diagnosed as a large cell neuroendocrine carcinoma with multiple skin metastases. Computed tomographic (CT) imaging found metastatic foci in the liver, pleura, bone, and lymph nodes. We were unable to identify the primary site of origin. To the best of our knowledge, this is the first case of a large cell neuroendocrine carcinoma with a primary manifestation of multiple skin metastases.

Keyword

Cytokeratin 20; Neuroendocrine carcinoma; Merkel cell carcinoma; Skin

MeSH Terms

Carcinoma, Merkel Cell
Carcinoma, Neuroendocrine
Chromogranin A
Humans
Keratin-20
Keratins
Liver
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Pleura
Skin
Synaptophysin
Chromogranin A
Keratin-20
Keratins
Synaptophysin

Figure

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  Fig. 1 Skin examination revealed multiple well-demarcated, skin-colored subcutaneous nodules on the trunk.

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  Fig. 2 Microscopic findings of a large cell neuroendocrine carcinoma. (A) Low-power view showing sheets of tumor cells with a trabecular or organoid growth pattern in the subcutaneous area. (B) High-power view showing large pleomorphic cells with hyperchromatic nuclei, coarse chromatin, and numerous mitotic figures (H&E, A: ×40, B: ×200, respectively).

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  Fig. 3 (A) Immunohistochemical staining for CD56 showed positivity for tumor cells in a cytoplasmic pattern. (B, C) Tumor cells were focally positive for chromogranin and synaptophysin. (D) CK20, showing diffuse cytoplasmic staining of tumor cells (Immunoperoxidase, ×100).

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