Carcinoid tumor with skin metastasis

An 80-year-old male patient presented with a 4-month history of nine extremely painful cutaneous nodules located on his forehead, neck, thorax, arms, and thighs. Biopsies of two nodules were performed. Routine histology, immunohistochemistry for chromogranin, as well as electron microscopy demonstrated that the nodules corresponded to cutaneous metastases of a carcinoid tumor, probably originated in the gastric antrum. The present description is, to the best of our knowledge, the first one to correlate the spontaneous and pressure-induced pain in the nodules with perineural invasion and neural sectioning by tumoral cells. S-100 protein and electron microscopy demonstrated numerous Langerhans cells among the tumoral cells.