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A 58-year-old man presented with 1-month history of several skin lesions on his scalp, which had started as a tiny skin-colored papule. This progressively enlarged to form a solitary 2 cm-sized tender tumor and several new lesions had developed. He had a history of rectal neuroendocrine carcinoma with multiple hepatic metastases.
Fig. 1. Tender, solitary, 1.7 cm-sized, well-demarcated, reddish tumor on the scalp.
Skin examination revealed a solitary well-demarcated, 1.7 cm-sized, reddish tumor and several papules affecting the scalp (Fig. 1). Histology of skin biopsy had revealed multiple tumor nest which showed the same histological features as the primary rectal tumor (Fig. 2A, 2B). Tumor cells are arranged in various sized nests, broad and irregular strands, or solid sheets with focal necrosis in the dermis. Tumor cells are usually large and polygonal with scanty eosinophilic cytoplasm, coarse or salt and pepper chromatins, and frequent nucleoli and high mitotic rate. Some rosette-like structures are found. Tumor cells are stained diffusely with neuron-specific enolase (NSE), CD56, a pan-neuroendocrine marker and are weakly with cytokeratin 20 (Fig. 3A, 3B).
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Fig. 2. (A) Multiple tumor cells arranged in irregular strands, or solid sheets (H & E, x 40). (B) The tumor cells are showing uniform, round to oval nuclei with scanty cytoplasm (H & E, x 400).
Fig. 3. (A) Immunohistochemical staining of tumor cells showing positivity for CD56 (x 100). (B) Immuno- histochemical staining of tumor cells showing positivity for cytokeratin 20 (x 100).
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