Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. due to metastatic gastric adenocarcinoma and review the relavant literature. CASE REPORT A 33-year-old woman was referred for a subcutaneous nodule on the surface of an erythematous-, hairless patch around the frontal scalp observed 3 months previously, to rule out metastasis from her known gastric adenocarcinoma diagnosed in January 2008. She had undergone total gastrectomy for the gastric carcinoma diagnosed in May 2007; she subsequently underwent 6 cycles of chemotherapy and total abdominal hysterectomy with bilateral salphingo-oophorectomy after being diagnosed with metastatic adenocarcinoma (Krukenberg cancer) in November 2007. Examination revealed no abnormalities besides a scalp lesion exhibiting a hard, movable, non-tender subcutaneous nodule covered with a slightly erythematous alopecic patch (Fig. 1). The patient did not report any previous dermatological diseases at the site of alopecia. Routine laboratory test results including full blood count, liver function, renal function, electrolytes, chest radiography and electrocardiogram were all normal. Histopathological examination of the scalp lesion showed decreased hair follicle cells, as well as metastatic adenocarcinoma cells interspersed between collagen bundles and around hair follicles (Fig. 2A, B). Similar to the original gastric cancer, tumor cells stained positively for tumor marker MSH-2, the DNA mismatch repair protein (Fig. 2C). The total gastrectomy specimen showed signet ring cells (Fig. 3A) and poorly differentiated adenocarcinoma cells (Fig. 3B) which stained positive for MSH-2 (Fig. 3C). MSH-2 is certainly a marker of a significant mismatch fix gene, MSH-2. Polymorphisms in the MSH-2 gene had been recently recommended to modulate a person’s susceptibility to gastric tumor3. Although there have been no signet band cells, the head specimen showed dispersed, differentiated poorly, MSH-2-positive carcinoma cells. Entire body positron emission tomography (Family pet) scanning demonstrated no other abnormal uptake than in the stomach (Fig. 3D). Following colonoscopy with biopsy also revealed no malignancy. PET scanning performed after Sotrastaurin cell signaling total abdominal hysterectomy with bilateral salphingo-oophorectomy in November 2007 revealed no remaining malignancy. Therefore, we concluded the scalp metastasis originated from the gastric cancer. Cutaneous metastasis usually exhibits features consistent with the underlying malignancy. However, Sotrastaurin cell signaling the metastasis may exhibit less differentiation and be more anaplastic. Therefore, we can infer that atrophy of the hair follicles and gastric cancer invaded the collagenous stroma, influencing the development of alopecia. On the basis of both clinical and histopathological findings, the patient was Sotrastaurin cell signaling diagnosed with alopecia neoplastica due to gastric adenocarcinoma. Despite performing the cancer chemotherapy, no hair regrowth was observed. Open in a separate windows Fig. 1 Subcutaneous nodule covered with erythematous, hairless patch around the frontal scalp. Open in a separate windows Fig. 2 (A) Histologic examination revealed decreased pilosebaceous models and scattered, infiltrated tumor cells around hair follicles, upper and mid-dermis (H&E, 40). (B) Metastatic adenocarcinoma cells were interspersed between collagen bundles and around hair follicles (H&E, Sotrastaurin cell signaling 200). (C) Tumor cells were positively stained against tumor marker MSH-2 (MSH-2, 200). Open in a separate windows Fig. 3 (A) Total gastrectomy specimen shows many signet ring cells (H&E, 200). Signet ring cells are magnified in inset (H&E, 400). (B) There are poorly differentiated tumor cells either DFNB53 (H&E, 200). (C) A part of poorly differentiated tumor cells were positively stained against tumor marker MSH-2 (MSH-2, 200). (D) Whole body fusion positron emission tomography scan performed Sotrastaurin cell signaling after diagnosed with stomach cancer shows abnormal FDG uptake on stomach and rectosigmoid. Following colonoscopy and colon biopsy revealed no other malignancy. DISCUSSION The.