Cutaneous metastasis from hepatocellular carcinoma resembling pyogenic granuloma

Abstract

A case of skin metastasis from hepatocellular carcinoma (HCC) is reported that resembled pyogenic granuloma. An easily bleeding, cutaneous nodule on the chin of a 62-year-old Japanese male was resected under the diagnosis of pyogenic granuloma. Histology, however, indicated HCC. Cutaneous metastases from HCC are very rare, but the possibility must be considered for unusual nodules resembling pyogenic granuloma.

Skin Metastasis From Hepatocarcinoma

“…No preference for any side of the body was noticed. In at least 5 cases, lesions showed a pyogenic granuloma-like clinical aspect 9,23,25,26,30 ; the current case was among them.…”

Cutaneous Metastasis of Occult Hepatocellular Carcinoma

“…2 The head appears to be the most frequent site of cutaneous and subcutaneous involvement. 4 Paradoxically, most of these metastases occur without lung involvement. 4,[11][12][13] Some authors have proposed that the major pathway of head metastases in HCC is the so-called Batson's plexus, a rich paravertebral network of veins.…”

“…4 Paradoxically, most of these metastases occur without lung involvement. 4,[11][12][13] Some authors have proposed that the major pathway of head metastases in HCC is the so-called Batson's plexus, a rich paravertebral network of veins. 13,14 These veins lack valves and may be capable of bypassing the pulmonary venous system, thus providing a plausible explanation for this underemphasized phenomenon.…”

“…13,14 These veins lack valves and may be capable of bypassing the pulmonary venous system, thus providing a plausible explanation for this underemphasized phenomenon. 4,[11][12][13][15][16][17][18] In summary, this metastatic HCC was initially diagnosed with FNA together with immunocytochemistry for antihepatocyte. HCCs should be considered in the differential diagnosis of carcinomas metastatic to the face, even in the absence of liver symptoms or lung metastases.…”

“…3 The most frequent sites of cutaneous metastasis in HCC appear to be the head. 4 This fact has been underestimated in the literature, and an accurate cytologic diagnosis is extremely difficult in patients with unknown liver dysfunction. We report the cytologic features of a face metastasis from an occult HCC.…”