Ann Dermatol.  2015 Aug;27(4):439-441. 10.5021/ad.2015.27.4.439.

A Case of Metastatic Gastric Adenocarcinoma Mimicking Preseptal Cellulitis

• Won KH
• Lee MH
• Lee WJ
• Won CH
• Chang SE
• Choi JH
• Moon KC
• Lee MW

• KMID: 2171503
• DOI: http://doi.org/10.5021/ad.2015.27.4.439

Abstract

Cutaneous metastasis from gastric adenocarcinoma is uncommon, and the eyelid is a rare metastatic site. Three patterns of clinical presentation of eyelid metastasis have been described: nodular, infiltrative, and ulcerated. The infiltrative pattern, also known as an inflammatory diffuse pattern or mask-like metastasis, can be easily misdiagnosed as cellulitis or contact dermatitis. Here, we report a case of gastric adenocarcinoma in a 75-year-old man who presented with a localized erythematous plaque on his eyelid that developed four months earlier. The patient had been treated with an antimicrobial agent owing to suspicion of preseptal cellulitis. Gastric adenocarcinoma metastasis was diagnosed on the basis of histopathological examination and immunophenotyping (i.e., cytoplasmic epithelial membrane antigen, cytokeratin- 7, cytokeratin-20, and carcinoembryonic antigen). For patients with malignant neoplasms, persistent skin lesions similar to cellulitis or contact dermatitis should be suspected of metastasis derived from an internal malignancy, even for very rare sites of metastasis.

Keyword

Adenocarcinoma; Eyelids; Neoplasm metastasis; Orbital cellulitis

MeSH Terms

Adenocarcinoma*
Aged
Cellulitis*
Cytoplasm
Dermatitis, Contact
Eyelids
Humans
Immunophenotyping
Keratin-20
Mucin-1
Neoplasm Metastasis
Orbital Cellulitis
Skin
Ulcer
Keratin-20
Mucin-1

Figure

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  Fig. 1 Localized relatively ill-demarcated erythematous swelling and indurations at the left upper and lower eyelids.

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  Fig. 2 (A) Histopathological examination revealing diffuse infiltration with tumor cells forming strands or clusters between the collagen bundles with some signet ring cells (H&E, ×200). (B, C) Expression of cytoplasmic epithelial membrane antigen (EMA) and cytokeratin-7 (CK7) can be observed in the tumor cells (immunoperoxidase stain for EMA and CK7, ×200).

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