Metastatic Hepatocellular Carcinoma of Skin Diagnosed With Hepatocyte Paraffin I and a-Fetoprotein Immunostainings
A rare case of skin metastasis of hepatocellular carcinoma diagnosed with an aid of immunohistochemical stainings of hepatocyte paraffin 1 and a-fetoprotein is reported in this study. An 86-year-old Japanese man was admitted to our hospital due to cutaneous mass in the right chest. An incisional biopsy was performed, which showed proliferation of malignant cells with eosinophilic or clear cytoplasm arranged in solid nests. No trabecular pattern was recognized. Sebaceous carcinoma, clear cell sarcoma, malignant granular cell tumor, metastatic renal cell carcinoma, and metastatic hepatocellular carcinoma were suspected on hematoxylin and eosin preparations. An immunohistochemical study showed that the tumor cells were positive for cytokeratins, hepatocyte paraffin 1, and a-fetoprotein but negative for vimentin, desmin, a-smooth muscle actin, S-100 protein, epithelial membrane antigen, carcinoembryonic antigen, chromogranin, neuron-specific enolase, CD10, CD30, CD34, CD45, CD68, and HMB45. Metastatic hepatocellular carcinoma of the skin was diagnosed pathologically. This case suggests that skin tumors with eosinophilic cytoplasm should be examined by hepatocyte paraffin 1 and a-fetoprotein.
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- "There are only a few case reports of each unusual metastatic site from HCC; in the diaphragma , in the pancreas , in the gall bladder , in the stomach , in the colon , in the adrenal gland , in the pleura , in the peritoneum , in the cervical lymph node , in the soft tissue , in the brain , in the skin  , and in the oral cavity . It was very interesting that the metastatic sites of the present 2 cases (skin and oral cavity) were the first manifestations of HCC. "
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ABSTRACT: The author examined unusual extrahepatic metastatic sites from liver hepatocellular carcinomas (HCCs) in autopsy and surgical files at our laboratory in the last 10 years. In autopsy cases (n=31), extrahepatic metastases were present in 21 cases (68%). The most common metastatic sites were lung (n=18). Unusual extrahepatic metastatic sites in the autopsy series were abdominal regional lymph nodes (n=6), bones (n=5), diaphragma (n=2), pancreas (n=2), gall bladder (n=1), stomach (n=1), colon (n=1), adrenal gland (n=1), pleura (n=1), peritoneum (n=1), cervical lymph nodes (n=1), and shoulder soft tissue (n=1). In surgical cases (n=21), in which extrahepatic tumors were excised, the lung was the most common, and accounted for 16 cases. The unusual extrahepatic metastatic sites in the surgical series were bones (n=2), brain (n=1), skin (n=1), and oral cavity (n=1). Immunohistochemical demonstration of HepPar1 and AFP were recognized in 12 of 12 surgical cases examined and 8 of the 12 surgical cases examined, respectively. Cytokeratin 8 and 18 were expressed in 6 of 6 surgical cases and 7 of 7 surgical cases examined. These data shows that HCC can metastasize in various organs other than the lung, and HepPar1 and AFP were good markers of extrahepatic metastases of these unusual sites of metastatic foci from HCC.
International journal of clinical and experimental pathology 05/2013; 6(5):816-20. · 1.89 Impact Factor
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ABSTRACT: Epithelioid angiosarcomas are extremely rare tumors associated with poor prognosis and early metastases. Its epithelioid cytomorphology and limited vasoformation make it difficult to distinguish from more common malignancies, such as, carcinoma. This can be a potential diagnostic pitfall for the cytopathologist. In this report, the patient is a 24-year-old man presenting with testicular pain, a pelvic mass, and innumerable liver nodules. Immediate interpretation of the needle core biopsies of the pelvic mass and liver lesions initially favored a poorly differentiated adenocarcinoma. Unusual positive immunohistochemical stains for CD30 and CK7 ultimately led the investigation toward a tumor of mesenchymal origin. Further, immunohistochemical evaluation demonstrated positive CD31 and Factor VIII staining and established the final diagnosis of epithelioid angiosarcoma. The tumor cells were negative for CD34, CK20, alpha-fetoprotein, placental-like alkaline phosphatase, hepatocyte paraffin 1, polyclonal carcinoembryonic antigen, CD10, CA-125, prostate-specific antigen, and prostatic acid phosphatase. This case is reported to illustrate the importance of considering the diagnosis of epithelioid angiosarcoma when encountering an “epithelioid” neoplasm particularly with unusual immunoreactivity for CK7 and CD30. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc.
Diagnostic Cytopathology 01/2009; 38(2):154 - 158. DOI:10.1002/dc.21187 · 1.12 Impact Factor
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ABSTRACT: Cutaneous metastasis is a rare occurrence but may be the presenting sign of a primary internal malignancy. Skin, breast, lung, gastrointestinal, and kidney are the most common primary malignancies to metastasize to skin. Common regions for cutaneous metastasis include the scalp, abdomen, chest, back, and extremities. The appearance of cutaneous metastasis is a pre-terminal occurrence and clinically a very poor prognostic sign.Skin cancer was the topic which was chosen, but it was decided to explore skin as a site of metastasis rather than primary melanoma, squamous cell, or basal cell carcinoma. A search and review of the literature on PubMed was performed to identify cases of cutaneous metastasis due to a variety of primary sources in adults, mainly breast, lung, skin, gastrointestinal, genitourinary, renal, and thyroid. Inclusion criteria for the review was most common types of cancer in adults, appearance of lesions, and cutaneous metastasis to distant regions rather than direct extension with the exception of breast cancer. Primary malignancies found in children, lymphomas, and leukemias were not included in this review.
Osteopathic Family Physician 01/2012; 4(1). DOI:10.1016/j.osfp.2011.09.005
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