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Correspondence |

In Vivo Reflectance Confocal Microscopy for Cutaneous Metastasis of Bladder Adenocarcinoma

Anna Sgambato, MD; Rosana Bortoli Buffon, MD; Carlo Cota, MD; Antonio Matroianni, MD; Marco Ardigò, MD
Arch Dermatol. 2009;145(2):213-215. doi:10.1001/archdermatol.2008.538.
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Cutaneous metastases from bladder carcinoma occur in less than 1% of patients with this malignant neoplasm and may represent the initial sign of a widespread disease.1 They typically appear as multiple or single well-circumscribed nodules, generally located at a single site, most frequently on the abdomen.1

Histologically, cutaneous bladder carcinoma metastases involve predominantly the dermis, with occasional extension into the subcutaneous tissue. Metastases often show growth of atypical epithelial cells among collagen bundles with a disordered pattern of mixed single narrow strands and large clusters of cells.1

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Figure.

Clinical, histopathologic, and reflectance confocal microscopic (RCM) images from our case. A, The clinical primary photograph shows a red, firm, nodular lesion on the scalp; the histologic inset shows dermal proliferation of epithelial structures with glandular differentiation (hematoxylin-eosin, original magnification ×200). B, This histologic image shows large, epidermotrophic, epithelial, neoplastic cells disposed in clusters (yellow box) and singly (arrow); in the dermis, aggregate cells (black box) manifest central glandular lumina (asterisk) (hematoxylin-eosin, original magnification ×400). C, On RCM (0.5 × 0.5 mm), at the level of the spinous layer, tumor cells appear singly (arrow) and in clusters (yellow square) as large, polygonal, refractile structures embedded in the epidermis. D, At the dermal level, on RCM (0.5 × 0.5 mm), tumor nests are composed of large, mildly refractile, polymorphic cells arranged in “palisading” array (black square) surrounding luminal areas filled with hyporefractile material (asterisk); tumor islands are surrounded by thickened and highly refractile collagen bundles. E, Notable are triangular to stellate highly refractile cells with long, thin dendrites located within the tumor nests (arrows).

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Correspondence

February 1, 2009
Anne Dompmartin, MD; Pascal Thibon, MD; Miikka Vikkula, MD, PhD; Laurence M. Boon, MD, PhD
Arch Dermatol. 2009;145(2):210-211. doi:10.1001/archdermatol.2008.568.
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