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An unusual metastatic localisation of squamous cell carcinoma of the lung
Sl18
ISM4 8
S0ciet.y tneeting
SM4. Europenn
An unusual metastatic localisation of squamous cell carcinoma of the lung
0. Vanhooteghemt, M. Dumontz, J. Andre3, M. Leempoelz. ‘Sainte-Elisabeth Hospital, Natnur: 2New Paul Brien Brussels: ‘University Hospital Saint-Pierre, Brussels,
Hospital, Belgium
Metastatic turnouts of the nail are rare. Primary tumours which metastasize to the fingertip or the nail are, in order of frequency: lung (50%), breast (15%). and kidney (14%). Clinically, nail metastases may be of two types: cutaneous and osseous. In this case, X-rays usually show an osteolytic focus. We report a manifestation of nail unit metastasis in a man with prim‘ary squamous cell carcinoma of the lung. In general, the presence of nail or fingertip metastase may be the frst manifestation of an internal neoplasm and is related to a poor prognosis, with a survival rate of less than 50% after 6 months. For this reason, physicians should be alert to this possibility when examining patients with similar unusual lesions.
SM4-9 Later0 subungual giant cell tumor of the ’ tendon sheath (GCTTS) B. Richertt, J. And&*. ‘Dertnatology 2Dertnatology
Unit,
Free
University
Unit, University of LiPge; of Brussels, Belgiunt
A 37 year old male patient consulted in our department for a laterosubungual lesion evolving for about ten years. Physical examination revealed a firm subcutaneous mass rising up the overlying nail plate which was thinned, splited, shortened and did not reach the free edge. There was neither fonctional impairment nor spontaneous or provoked pain by pressure. There is no history of traumatism. X-ray examination was normal. Partial nail avulsion revealed a very firm yellow orange pea-size nodular lesion, filling the posterior two thirds of the lateral nail fold and a part of the underlying pulp. Light microcopic examination of the exisional specimen diagnosed a GC‘ITS. This tumor is the second most frequent benign tumor of the hand. Although it is mentionned in textbooks to involve the vicinity of the nail apparatus, its occurrence in this location seems exceptional, since only one case has been reported in the literature (1). [l] Abimelec Ph et al.: Subungual giant cell tumor of the tendon sheath. Cutis 1996; 58: 273-275.
1SM4-10 1 Subungual eccrine poroma: A report of three cases S. Goettmannt, E. Marinho*, M. Grossin?, S. Belaich’. From the ‘Departments of Dertnatology; ‘Pathology, Bichat Teaching
Hospital,
Paris,
France
Eccrine poromas are benign tumors arising from the intraepidermal portion of the eccrine sweat gland excretory duct. They develop selectively on the hairless areas of the foot. The nail bed does not contain any appendages. In the only reported case of eccrine poroma located to the nail system (Arenas), the tumor involved the entire distal phalanx. We report three cases of subungual eccrine poroma of the nail apparatus of the great toe. They manifest as distal or distolateral
Nuil Society
Syntposiunt
onycholysis; after removal of the overlying nail plate, tumors looked like an epidermized botryomycoma. The tumors were removed surgically and found to exhibit similar histologic features. They were globular epithelial growths in continuity with the epithelium; the tumor cells were small and devoid of cytoplasmic or nuclear atypias. Each cell had one basophilic nucleus. A few duct-like structures were scattered throughout the tumors, revealing their sweat-gland origin. The stroma was fbrohyaline. The tumors were clearly demarcated from the adjacent epidermis. Localization to the nail system is exceedingly rare. In the single reported case (Arenas), a large papillomatous tumor involved the entire distal phalanx of the second toe. ‘Iwo cases of periungual porocarcinoma have been reported. Both arose from the lateral nail fold. In one, the epidermal component of the lesion was seen only at the junction between the lateral nail fold and the nail bed, suggesting that the tumor arose from this area (Van Gorp). Since both the nail matrix and the nail bed are devoid of appendages, it can be concluded that eccrine poromas of the nail system extend from the hyponychium or nail fold. References [ 11 Arenas R.. Poroma Ecrino in: Dermatologia: Atlas, diagnosico y tratamiento, 142-539-142-540 Eds McGraw-Hill [2] Van Gorp J., Van Der Putte S.C.J. Perlungual Eccrine Porocarcinoma Dermatology 1993: 187: 67-70
SM4-11 Subungueal neurofibroma Ch. Dangoisset, J. Van Geertruyden*, G. De Dobbeleer’, J. Andre’. ‘Dertnatology; 2Plastic Surgery, University of Brussels,
Belgium
A 43-year old woman presents with an onychodystrophy of her right great toenail. The lesion initially appeared 4 to 5 years before as a blue-red discoloration of the proximal nail plate. Physical examination demonstrates a proximal subungueal tumor with a blue-red discoloration and a thin and irregular nail plate in regard. The mass is soft, easily depressible and very slightly painful on direct pressure. X-rays shows an important bone print in the distal phalanx due to tumoral compression but without sign of bone invasion, Surgical excision is performed and histopathological examination supports the diagnosis of neurolibroma. Subungueal neurofibroma is exceptional This slow growing nail tumor may cause onychodystrophy and as in our case, so far never reported, a circumscribed blue-red discoloration. The patient should be carefully examined to detect any other sign of neurotibromatosis. Our case report points up the interest of exploratory nail plate removal in the difficult differential diagnosis of the nail bed tumors. References [I] Niizuma K., Iijima K.N.: Solitary neurotibroma: a case of subungueal neurotibroma on the right thiid finger, Arch. Dermatol. Res., 1991.283,13-15
ISM4 8
S0ciet.y tneeting
SM4. Europenn
An unusual metastatic localisation of squamous cell carcinoma of the lung
0. Vanhooteghemt, M. Dumontz, J. Andre3, M. Leempoelz. ‘Sainte-Elisabeth Hospital, Natnur: 2New Paul Brien Brussels: ‘University Hospital Saint-Pierre, Brussels,
Hospital, Belgium
Metastatic turnouts of the nail are rare. Primary tumours which metastasize to the fingertip or the nail are, in order of frequency: lung (50%), breast (15%). and kidney (14%). Clinically, nail metastases may be of two types: cutaneous and osseous. In this case, X-rays usually show an osteolytic focus. We report a manifestation of nail unit metastasis in a man with prim‘ary squamous cell carcinoma of the lung. In general, the presence of nail or fingertip metastase may be the frst manifestation of an internal neoplasm and is related to a poor prognosis, with a survival rate of less than 50% after 6 months. For this reason, physicians should be alert to this possibility when examining patients with similar unusual lesions.
SM4-9 Later0 subungual giant cell tumor of the ’ tendon sheath (GCTTS) B. Richertt, J. And&*. ‘Dertnatology 2Dertnatology
Unit,
Free
University
Unit, University of LiPge; of Brussels, Belgiunt
A 37 year old male patient consulted in our department for a laterosubungual lesion evolving for about ten years. Physical examination revealed a firm subcutaneous mass rising up the overlying nail plate which was thinned, splited, shortened and did not reach the free edge. There was neither fonctional impairment nor spontaneous or provoked pain by pressure. There is no history of traumatism. X-ray examination was normal. Partial nail avulsion revealed a very firm yellow orange pea-size nodular lesion, filling the posterior two thirds of the lateral nail fold and a part of the underlying pulp. Light microcopic examination of the exisional specimen diagnosed a GC‘ITS. This tumor is the second most frequent benign tumor of the hand. Although it is mentionned in textbooks to involve the vicinity of the nail apparatus, its occurrence in this location seems exceptional, since only one case has been reported in the literature (1). [l] Abimelec Ph et al.: Subungual giant cell tumor of the tendon sheath. Cutis 1996; 58: 273-275.
1SM4-10 1 Subungual eccrine poroma: A report of three cases S. Goettmannt, E. Marinho*, M. Grossin?, S. Belaich’. From the ‘Departments of Dertnatology; ‘Pathology, Bichat Teaching
Hospital,
Paris,
France
Eccrine poromas are benign tumors arising from the intraepidermal portion of the eccrine sweat gland excretory duct. They develop selectively on the hairless areas of the foot. The nail bed does not contain any appendages. In the only reported case of eccrine poroma located to the nail system (Arenas), the tumor involved the entire distal phalanx. We report three cases of subungual eccrine poroma of the nail apparatus of the great toe. They manifest as distal or distolateral
Nuil Society
Syntposiunt
onycholysis; after removal of the overlying nail plate, tumors looked like an epidermized botryomycoma. The tumors were removed surgically and found to exhibit similar histologic features. They were globular epithelial growths in continuity with the epithelium; the tumor cells were small and devoid of cytoplasmic or nuclear atypias. Each cell had one basophilic nucleus. A few duct-like structures were scattered throughout the tumors, revealing their sweat-gland origin. The stroma was fbrohyaline. The tumors were clearly demarcated from the adjacent epidermis. Localization to the nail system is exceedingly rare. In the single reported case (Arenas), a large papillomatous tumor involved the entire distal phalanx of the second toe. ‘Iwo cases of periungual porocarcinoma have been reported. Both arose from the lateral nail fold. In one, the epidermal component of the lesion was seen only at the junction between the lateral nail fold and the nail bed, suggesting that the tumor arose from this area (Van Gorp). Since both the nail matrix and the nail bed are devoid of appendages, it can be concluded that eccrine poromas of the nail system extend from the hyponychium or nail fold. References [ 11 Arenas R.. Poroma Ecrino in: Dermatologia: Atlas, diagnosico y tratamiento, 142-539-142-540 Eds McGraw-Hill [2] Van Gorp J., Van Der Putte S.C.J. Perlungual Eccrine Porocarcinoma Dermatology 1993: 187: 67-70
SM4-11 Subungueal neurofibroma Ch. Dangoisset, J. Van Geertruyden*, G. De Dobbeleer’, J. Andre’. ‘Dertnatology; 2Plastic Surgery, University of Brussels,
Belgium
A 43-year old woman presents with an onychodystrophy of her right great toenail. The lesion initially appeared 4 to 5 years before as a blue-red discoloration of the proximal nail plate. Physical examination demonstrates a proximal subungueal tumor with a blue-red discoloration and a thin and irregular nail plate in regard. The mass is soft, easily depressible and very slightly painful on direct pressure. X-rays shows an important bone print in the distal phalanx due to tumoral compression but without sign of bone invasion, Surgical excision is performed and histopathological examination supports the diagnosis of neurolibroma. Subungueal neurofibroma is exceptional This slow growing nail tumor may cause onychodystrophy and as in our case, so far never reported, a circumscribed blue-red discoloration. The patient should be carefully examined to detect any other sign of neurotibromatosis. Our case report points up the interest of exploratory nail plate removal in the difficult differential diagnosis of the nail bed tumors. References [I] Niizuma K., Iijima K.N.: Solitary neurotibroma: a case of subungueal neurotibroma on the right thiid finger, Arch. Dermatol. Res., 1991.283,13-15