L Prieto-Torres1, M Llamas-Velasco2, S Machan3, R Haro3, S de Asis4, M Carmo5, A Loredo6, C del Puerto7, I Fried8, W Kempf9, L Cerroni8, L Requena3. 1. Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 2. Department of Dermatology, Hospital Universitario de la Princesa, Universidad Autónoma, Madrid, Spain. 3. Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain. 4. Department of Dermatology, Hospital Universitario Doctor Peset, Valencia, Spain. 5. Department of Pathology, Instituto Português de Oncología de Lisboa Francisco Gentil, Lisboa, Portugal. 6. Department of Pathology, CMN 20 de Noviembre-ISSSTE, Ciudad de México, Mexico. 7. Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 8. Dermatopathology Research Unit, Medical University of Graz, Graz, Austria. 9. Kempf und Pfaltz Histologische Diagnostik, Zürich, Switzerland.
Abstract
BACKGROUND: Paclitaxel and docetaxel are antineoplastic drugs that bind the microtubules, producing the arrest of mitoses, which may be seen histopathologically. These histopathologic changes may simulate an intraepidermal keratinocytic malignant neoplasm, and an accurate diagnosis may be only established by clinicopathological correlation. OBJECTIVES: We report six cases of cutaneous eruptions by taxanes in which a striking cytotoxic effect was evident histopathologically. METHODS: Cutaneous biopsies were obtained in each patient. RESULTS: Atypical starburst-like or ring-like mitoses and dyskeratosis on basal and suprabasal layers of the epidermis. Areas of squamous syringometaplasia were also seen in one case. DISCUSSION: These findings were interpreted as expression of mitotic arrest due to taxanes. Similar changes have been described in association with other chemotherapeutic drugs such as vincristine, podophyllin and its derivative etoposide; colchicine, busulfan and maytansine, but cases like ours due to taxanes are exceptional or under-reported. CONCLUSION: Dermatopathologists should be aware of these effects in order to interpret carefully cutaneous biopsy specimens of patients receiving taxanes.
BACKGROUND:Paclitaxel and docetaxel are antineoplastic drugs that bind the microtubules, producing the arrest of mitoses, which may be seen histopathologically. These histopathologic changes may simulate an intraepidermal keratinocytic malignant neoplasm, and an accurate diagnosis may be only established by clinicopathological correlation. OBJECTIVES: We report six cases of cutaneous eruptions by taxanes in which a striking cytotoxic effect was evident histopathologically. METHODS: Cutaneous biopsies were obtained in each patient. RESULTS: Atypical starburst-like or ring-like mitoses and dyskeratosis on basal and suprabasal layers of the epidermis. Areas of squamous syringometaplasia were also seen in one case. DISCUSSION: These findings were interpreted as expression of mitotic arrest due to taxanes. Similar changes have been described in association with other chemotherapeutic drugs such as vincristine, podophyllin and its derivative etoposide; colchicine, busulfan and maytansine, but cases like ours due to taxanes are exceptional or under-reported. CONCLUSION: Dermatopathologists should be aware of these effects in order to interpret carefully cutaneous biopsy specimens of patients receiving taxanes.