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Cutaneous Metastases from Primary Hepatobiliary Tumors as the First Sign of Tumor Recurrence following Liver Transplantation.

Hauch AT, Buell JF, McGowan M, Bhatia P, Lewin E, Killackey M, Shores NJ, Balart LA, Moehlen M, Saggi B, Paramesh AS - Case Rep Transplant (2014)

Bottom Line: Cutaneous metastasis from hepatobiliary tumors is a rare event, especially following liver transplantation.We report our experience with two cases of cutaneous metastases from both hepatocellular carcinoma and mixed hepatocellular/cholangiocarcinoma following liver transplantation, along with a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Tulane Transplant Institute, Tulane University School of Medicine, 1415 Tulane Avenue, HC-5, New Orleans, LA 70112, USA.

ABSTRACT
Cutaneous metastasis from hepatobiliary tumors is a rare event, especially following liver transplantation. We report our experience with two cases of cutaneous metastases from both hepatocellular carcinoma and mixed hepatocellular/cholangiocarcinoma following liver transplantation, along with a review of the literature.

No MeSH data available.


Related in: MedlinePlus

(a) H&E staining of abdominal wall excisional biopsy showing nodules of tumor cells with intervening entrapped soft tissue. Tumor cells demonstrate large variation in size with moderate nuclear pleomorphism; many tumor cells show cytoplasmic clearing. (b) Tumor cells show strong focal cytoplasmic reactivity for HepPar-1 supporting a diagnosis of metastatic HCC. (c) H&E staining of punch biopsy of skin showing tumor cells in the dermis streaming in cords and trabeculae with occasional gland-like formations. Tumor cells are hyperchromatic with increased nuclear-to-cytoplasmic ratio. (d) Tumor cells highlighted by CK7 immunohistochemistry (brown), showing diffuse strong cytoplasmic reactivity. Tumor cells were also positive for EMA and focally positive for mucicarmine; CK20, HepPar-1, CDX-2, and PSA were negative. The immunoprofile (CK7(+), CK20(−), and HepPar-1(−)) supports biliary over hepatic origin but is not definitive.
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fig2: (a) H&E staining of abdominal wall excisional biopsy showing nodules of tumor cells with intervening entrapped soft tissue. Tumor cells demonstrate large variation in size with moderate nuclear pleomorphism; many tumor cells show cytoplasmic clearing. (b) Tumor cells show strong focal cytoplasmic reactivity for HepPar-1 supporting a diagnosis of metastatic HCC. (c) H&E staining of punch biopsy of skin showing tumor cells in the dermis streaming in cords and trabeculae with occasional gland-like formations. Tumor cells are hyperchromatic with increased nuclear-to-cytoplasmic ratio. (d) Tumor cells highlighted by CK7 immunohistochemistry (brown), showing diffuse strong cytoplasmic reactivity. Tumor cells were also positive for EMA and focally positive for mucicarmine; CK20, HepPar-1, CDX-2, and PSA were negative. The immunoprofile (CK7(+), CK20(−), and HepPar-1(−)) supports biliary over hepatic origin but is not definitive.

Mentions: The patient initially had good liver function but developed recurrent HCV liver disease about one year after transplant and was initiated on antiviral therapy with an interferon, ribavirin, and boceprevir protocol. In December 2013 the patient developed several violaceous, painful, firm, immobile skin lesions on his right anterior chest wall, several inches from his transplant incision (Figure 1(a)). These lesions were biopsied and demonstrated subcutaneous metastatic well-differentiated HCC (Figure 2(a)). Immunohistochemical staining was positive for HepPar-1 (Figure 2(b)). Interestingly, imaging did not reveal any evidence of intrahepatic or pulmonary HCC recurrence. The patient had undergone a percutaneous biopsy of his HCC pretransplant, but this had been done in October of 2010, more than three years earlier. His alpha-fetoprotein (AFP) levels were never elevated.


Cutaneous Metastases from Primary Hepatobiliary Tumors as the First Sign of Tumor Recurrence following Liver Transplantation.

Hauch AT, Buell JF, McGowan M, Bhatia P, Lewin E, Killackey M, Shores NJ, Balart LA, Moehlen M, Saggi B, Paramesh AS - Case Rep Transplant (2014)

(a) H&E staining of abdominal wall excisional biopsy showing nodules of tumor cells with intervening entrapped soft tissue. Tumor cells demonstrate large variation in size with moderate nuclear pleomorphism; many tumor cells show cytoplasmic clearing. (b) Tumor cells show strong focal cytoplasmic reactivity for HepPar-1 supporting a diagnosis of metastatic HCC. (c) H&E staining of punch biopsy of skin showing tumor cells in the dermis streaming in cords and trabeculae with occasional gland-like formations. Tumor cells are hyperchromatic with increased nuclear-to-cytoplasmic ratio. (d) Tumor cells highlighted by CK7 immunohistochemistry (brown), showing diffuse strong cytoplasmic reactivity. Tumor cells were also positive for EMA and focally positive for mucicarmine; CK20, HepPar-1, CDX-2, and PSA were negative. The immunoprofile (CK7(+), CK20(−), and HepPar-1(−)) supports biliary over hepatic origin but is not definitive.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4120480&req=5

fig2: (a) H&E staining of abdominal wall excisional biopsy showing nodules of tumor cells with intervening entrapped soft tissue. Tumor cells demonstrate large variation in size with moderate nuclear pleomorphism; many tumor cells show cytoplasmic clearing. (b) Tumor cells show strong focal cytoplasmic reactivity for HepPar-1 supporting a diagnosis of metastatic HCC. (c) H&E staining of punch biopsy of skin showing tumor cells in the dermis streaming in cords and trabeculae with occasional gland-like formations. Tumor cells are hyperchromatic with increased nuclear-to-cytoplasmic ratio. (d) Tumor cells highlighted by CK7 immunohistochemistry (brown), showing diffuse strong cytoplasmic reactivity. Tumor cells were also positive for EMA and focally positive for mucicarmine; CK20, HepPar-1, CDX-2, and PSA were negative. The immunoprofile (CK7(+), CK20(−), and HepPar-1(−)) supports biliary over hepatic origin but is not definitive.
Mentions: The patient initially had good liver function but developed recurrent HCV liver disease about one year after transplant and was initiated on antiviral therapy with an interferon, ribavirin, and boceprevir protocol. In December 2013 the patient developed several violaceous, painful, firm, immobile skin lesions on his right anterior chest wall, several inches from his transplant incision (Figure 1(a)). These lesions were biopsied and demonstrated subcutaneous metastatic well-differentiated HCC (Figure 2(a)). Immunohistochemical staining was positive for HepPar-1 (Figure 2(b)). Interestingly, imaging did not reveal any evidence of intrahepatic or pulmonary HCC recurrence. The patient had undergone a percutaneous biopsy of his HCC pretransplant, but this had been done in October of 2010, more than three years earlier. His alpha-fetoprotein (AFP) levels were never elevated.

Bottom Line: Cutaneous metastasis from hepatobiliary tumors is a rare event, especially following liver transplantation.We report our experience with two cases of cutaneous metastases from both hepatocellular carcinoma and mixed hepatocellular/cholangiocarcinoma following liver transplantation, along with a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Tulane Transplant Institute, Tulane University School of Medicine, 1415 Tulane Avenue, HC-5, New Orleans, LA 70112, USA.

ABSTRACT
Cutaneous metastasis from hepatobiliary tumors is a rare event, especially following liver transplantation. We report our experience with two cases of cutaneous metastases from both hepatocellular carcinoma and mixed hepatocellular/cholangiocarcinoma following liver transplantation, along with a review of the literature.

No MeSH data available.


Related in: MedlinePlus