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CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 122-124

Cutaneous metastasis of internal malignancy


Department of Surgery, Rajiv Institute of Medical Sciences, Kadapa, Andhra Pradesh, India

Date of Web Publication21-May-2013

Correspondence Address:
G Mallikarjuna Rao
Rajiv Institute of Medical Sciences, Kadapa, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.112341

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  Abstract 

Cutaneous metastases of the hepatocellular carcinoma are very rare. The metastases are usually manifested on the face, scalp, chest, and abdomen. Skin metastasis is symptom of progressive disease and usually a sign of poor prognosis. It can be the first sign of the disease. The entire skin should be carefully inspected whenever, malignant disease is suspected. We report a case of skin metastasis of hepatocellular carcinoma for its rarity.

Keywords: Cutaneous metastasis, hepatocellular carcinoma, prognosis


How to cite this article:
Rao G M, Pavani M, Giridhar T, Mohan M. Cutaneous metastasis of internal malignancy. J NTR Univ Health Sci 2013;2:122-4

How to cite this URL:
Rao G M, Pavani M, Giridhar T, Mohan M. Cutaneous metastasis of internal malignancy. J NTR Univ Health Sci [serial online] 2013 [cited 2019 Nov 20];2:122-4. Available from: http://www.jdrntruhs.org/text.asp?2013/2/2/122/112341


  Introduction Top


Most common sites of cutaneous metastases are face, scalp, chest, and abdomen and those from the primary carcinoma of the liver are very rare [1] Diagnosis depends on clinical correlation with ultrasound, fine needle aspiration cytology (FNAC), and histopathological examination. [2],[3] We report a rare case of cutaneous metastasis of hepatocellular carcinoma in a 65-year-old man.


  Case Report Top


A 65-year-old man presented with multiple painless nodules all over the trunk since 2 months [Figure 1]. Size of the nodules varied from 1 cm to 2 cm. They were firm in consistency and non-tender. Past and family history was not significant. Systemic examination was normal.
Figure 1: Multiple nodules over the trunk

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Routine laboratory investigations were normal. Radiography of the chest revealed bilateral lung infiltrations. Ultrasonography of the abdomen revealed a single 5 cm × 5 cm of hypo-echoic lesion with other multiple lesions in the right lobe of liver. Computerized tomography of abdomen revealed similar features in the liver [Figure 2]. FNAC of the nodule in low power view shows large round to polygonal cells with round vesicular nuclei, prominent nucleoli, with eosinophilic granular cytoplasm, tumor cells arranged as small clusters and discretely, with occasional lymphocytes [Figure 3]. FNAC of the liver lesion shows, clusters of large round to polygonal cells with hyperchromatic, vesicular nucleus with prominent nucleoli with scanty to moderate cytoplasm [Figure 4], revealed the features of hepatocellular carcinoma. The histopathological examination of the nodule shows solid clusters, pseudoglandular pattern of tumor cells with intervening muscle bundles [Figure 5]. Viral markers were negative and alpha feto protein was within normal limits. Tumor cells were positive for keratin and hepatocyte specific antigen and negative for S 100 protein. The patient was referred to medical oncologist for further management.
Figure 2: Computed tomography abdomen showing hypo-echoic lesion

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Figure 3: Fine needle aspiration cytology nodule shows clusters of tumor cells

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Figure 4: Fine needle aspiration cytology liver showing clusters of large round to polygonal cells with hyperchromatic, vesicular nucleus with prominent nucleoli with scanty to moderate cytoplasm

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Figure 5: Histopathology of nodule showing solid clusters, pseudoglandular pattern of tumor cells with intervening muscle bundles

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  Discussion Top


Cutaneous metastases of malignant lesions occur in 3-5% of patients. Metastasis to the skin from internal malignancies is very uncommon. [4] The most common cancers that metastasize to the skin are from lung or breast. [1] Cutaneous metastasis can present as the first clinical sign of hepatocellular carcinoma. [2] Skin nodules are mostly found on face, scalp, chest, and shoulder. [1],[5] These lesions may provide the first indication in a patient with known primary tumor [2] or they may be the only presenting feature of an unsuspected primary tumor. Histopathological examination of the skin metastasis may reveal the identity of the primary tumor. [1] Cutaneous metastasis reach the skin by direct invasion or through the lymphatics or blood vessels. [2] The interesting observation has been made that the skin metastasis tend to be close to the site of the primary tumor. [1] The most common primary sites are the lung, stomach, kidney, thyroid, and the prostate in man and breast, uterus, and ovary in women.


  Conclusion Top


Cutaneous nodules should be considered as one of the differential diagnosis for a metastasis from an unknown primary. It is very uncommon manifestation of hepatocellular carcinoma. The present case should increase awareness of their existence.

 
  References Top

1.Ruben S, Owen D, Lee P, Weiss A. Hepatocellular carcinoma with cutaneous metastasis. Can J Gastroenterol 2009;23:23-5.  Back to cited text no. 1
    
2.Amador A, Monforte NG, Bejarano N, Martí J, Artigau E, Navarro S, et al. Cutaneous metastasis from hepatocellular carcinoma as the first clinical sign. J Hepatobiliary Pancreat Surg 2007;14:328-30.  Back to cited text no. 2
    
3.de Galdeno CS. Giant cutaneous metastasis from hepato cellular carcinoma. J Eur Acad Dermatol Venereol 1997;9:215.  Back to cited text no. 3
    
4.Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol 1990;22:19-26.  Back to cited text no. 4
    
5.Reingold IM, Smith BR. Cutaneous metastases from hepatomas. Arch Dermatol 1978;114:1045-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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[Pubmed] | [DOI]



 

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