Cutaneous metastasis as the first manifestation of neuroendocrine neoplasm of the lung: A case report

Introduction. Neuroendocrine neoplasms are rare heterogeneous malignancies that may occur in almost any organ in the body. These neoplasms are associated with a wide range of clinical and pathophysiological manifestations. Case Report. A 67-year-old female patient, non-smoker with a history of rheumatoid arthritis and osteoporosis, visited her general practitioner complaining of back pain, heart palpitations, and change in stool consistency. Physical examination revealed multiple subcutaneous nodules in the neck and chest area that were painful to touch. Due to suspected hyperthyroidism, she was referred to an endocrinologist. The ultrasound of the thyroid gland showed multiple cysts in the right lobe and a nodule in the left lobe of the thyroid gland. Laboratory tests showed elevated calcitonin and carbohydrate antigen levels. Based on the assumption that medullary thyroid carcinoma was the most likely diagnosis, she was referred to the Nuclear Medicine Department of the Oncology Institute of Vojvodina. A fine-needle aspiration biopsy of the left thyroid nodule was done and thyroid malignancy was excluded. By histopathological analysis of the enlarged right chest lymph node and a skin lump on the left loin, a lung cancer with neuroendocrine morphology with positive neuroendocrine markers was diagnosed. Computed tomography revealed a tumor infiltrating the left hilum with metastases. Conclusion. Skin metastases of neuroendocrine neoplasms are rare and may occur in any part of the human body. They may develop before the primary tumor is recognized and are associated with disseminated malignancy. Diagnosis and treatment are important to control the disease and improve the quality of life of patients.