title: Cutaneous metastasis of pancreatic carcinoma as an initial symptom in the lower extremity with obstructive lymphedema treated by physiotherapy and lymphaticovenous shunt: a case report, review, and pathophysiological implications.
abstract: Cutaneous metastasis from pancreatic cancer is relatively rare as an initial symptom, and it is generally localized on the periumbilical area that is known as Sister Mary Joseph's nodule. We report a rare case of a 49-year-old female who developed cutaneous metastasis of pancreatic cancer as an initial symptom. The patient was referred to our department for treatment of lymphedema due to surgical treatment of cervical cancer and underwent combined physiotherapy and, 2 months later, a lymph venous anastomosis (LVA) for treatment of the lymphedema. Two months after the operation, she developed erythema on her right leg which spread from the leg to the groin in series. This pattern corresponded to the direction of lymph drainage, which may have been enhanced by the conservative physiotherapy and LVA treatments. These facts suggest a possible relationship between cutaneous metastasis of carcinoma and treatment for lymphedema. Alternatively, the lymphedematous limb may be a privileged site for cancer growth, and metastatic seeding could have taken place from pre-existing hematogenous spread at the time of operation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan. shimizu-ykh@umin.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: J
authors.initials: J
authors.lastname: Maegawa
authors.forename: T
authors.initials: T
authors.lastname: Ho
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: T
authors.initials: T
authors.lastname: Mikami
authors.forename: K
authors.initials: K
authors.lastname: Nagahama
mesh_terms: D000714:Anastomosis, Surgical; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007866:Leg; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000628:therapy*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D026741:Physical Therapy Modalities; D012878:Skin Neoplasms / Q000556:secondary*; D002583:Uterine Cervical Neoplasms / Q000601:surgery