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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
Address for correspondence: Dr. Shamim Ahmed Shamim, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: sashamim2002@yahoo.co.in
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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
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 1a and 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 2a], arrow], with the presence of moderate amount of extracellular dermal mucin [Figure 2b]. 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 3a-e] with increased FDG uptake in the cutaneous region overlying the nasal region [Figure 4a-f]. Biopsy from the left para-aortic lymph nodes was consistent with metastasis from epithelial origin ovarian carcinoma.
Ovarian malignancies are associated with multiple cutaneous paraneoplastic associations that include acanthosis nigricans, Raynaud's phenomenon, scleroderma, dermatomyositis, and palmar fasciitis with polyarthritis.[1234567] Paraneoplastic cutaneous mucinosis, although very rare, has been reported in the literature in association with pulmonary and hematologic malignancies.[89] 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.
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Conflicts of interest
There are no conflicts of interest.
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