Violaceous nodules in a patient with endometrial adenocarcin
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A 65-year-old female with chemotherapy resistant endometrioid endometrial adenocarcinoma, presented with an 8-month history of firm violaceous nodules on her right leg. She complained of worsening right leg pain and chronic edema isolated to her right lower leg after local radiation therapy for known iliopsoas metastases. Physical exam revealed an edematous right lower extremity, with pitting edema of her right lower leg, and numerous scattered indurated violaceous nodules on her right thigh and right proximal lower leg. Punch biopsies were performed. The neoplastic cells were immunopositive for CK7 but negative for GATA3, CDX2, and CK20.

Cutaneous endometrial metastases can be present with a variety of morphologies, including nodules, plaques, and ulcers and most commonly occurs at the site of initial surgical or radiological treatment. Histopathology it reflects the features of a metastatic adenocarcinoma, but may not conclusively identify the site of origin. While endometrial carcinoma is among the more common malignancies in women, it rarely metastasizes to the skin and represents less than 1% of cutaneous metastases. However, identification of these metastases is important for their prognostic implication, which is poor and frequently leads patients to undergo palliative care.

While there are no specific antibody stains for endometrial adenocarcinoma, immunohistochemistry can support an endometrial origin and exclude more common sources of metastatic adenocarcinoma. Endometrial adenocarcinoma is positive for CK7 and ER/PR but negative for CK20.5 CEA, GATA-3, and caudal-type homeobox transcription factor 2 (CDX2) are negative in endometrial adenocarcinoma. CEA is overexpressed in gastrointestinal, lung, and breast carcinomas, GATA-3 is sensitive and specific for breast and urothelial carcinomas, and CDX2 is frequently expressed by intestinal tumors.