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Primary cutaneous phalangeal neuroendocrine/squamous cell carcinoma with mixed axillary metastasis
  1. Tom V McIntyre1,
  2. Tara M Connelly1,2,
  3. Kevin O'Hare3 and
  4. Amy Gillis1
  1. 1General Surgery, Tallaght University Hospital, Dublin, Ireland
  2. 2Surgery, University Hospital Waterford, Waterford, Ireland
  3. 3Histopathology, Tallaght University Hospital, Dublin, Ireland
  1. Correspondence to Tara M Connelly; tara_conn{at}


Cutaneous neuroendocrine tumours are rare and aggressive tumours associated with advanced age and immunosuppression. They are typically characterised by a high rate of local recurrence and nodal disease. The presence of a mixed squamous cell component is rare. These tumours are uncommonly found on the hand. We present a case and histological images of a 78-year-old woman with a primary CK20 negative TTF-1 positive cutaneous neuroendocrine tumour with squamous dedifferentiation arising from the fifth digit with axillary metastasis showing a mixed phenotype. Initial biopsy of the lesion was positive for chromogranin, synaptophysin and TTF-1, but negative for CK20, Melan-A and S100. After CT of the thorax abdomen and pelvis and octreotide single positron emission CT demonstrated a 15 mm axillary metastasis and no evidence of distal disease, our patient underwent an amputation of the affected digit and an axillary lymph node dissection. She is currently awaiting adjuvant chemoradiotherapy. Only two cases are reported in the literature to have mixed squamous/neuroendocrine features. We present the first case which is CK20 negative and TTF-1 positive.

  • skin cancer
  • general surgery
  • surgical oncology

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  • Contributors TVM and TC contributed equally to the paper, through performing the literature review and writing the manuscript. KO’H prepared and read the histopathological and immunohistochemical slides and contributed to the literature review. AG was the treating consultant and oversaw the management of the case and edited and assisted in preparation of the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.