Cutaneous metastatic cholangiocarcinoma: a report of three cases and review of the literature

Abstract

Cutaneous metastasis from cholangiocarcinoma is an extremely rare event. Herein, we present three cases with review of the literature. Case 1 is that of a young female with scalp metastasis. Cases 2 and 3 involve cutaneous metastasis to the sites of prior biliary drains, one occurring in a young female with a history of multiple biliary surgeries and one in a male with a history of sclerosing cholangitis. Review of the literature shows that the presentation of cutaneous metastases from cholangiocarcinoma can vary in terms of anatomic location and clinical features. The pathological and immunohistochemical profile of metastatic cholangiocarcinoma can be non-specific, and accurate diagnosis relies in part on clinical correlation. In summary, metastatic disease should always be included in the differential diagnosis of cutaneous lesions in patients with known malignancy.

Cutaneous Metastases From Internal Malignancies

“…148 Cutaneous metastasis from cholangiocarcinoma is an extremely rare event, and less than 30 cases have been published in the literature. 149 They may be solitary or multiple and usually show sudden onset and rapid growth. Typically, they are located on the abdominal wall at the exit site of a percutaneous biliary drain.…”

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

“…Cholangiocarcinoma tends to spread to adjacent organs with less than thirty cases of cutaneous metastases described in the literature [7]. …”

“…Neoplastic hepatocyte cells express immunoreactivity for polyclonal carcinoembryonic antigen (CEA), AFP, cytokeratins (CK) 8 and 18, and hepatocyte paraffin-1 (HepPar-1) (an antigen of the hepatocyte mitochondria) monoclonal antibody, which has been considered as the most specific and sensitive marker of normal and neoplastic hepatocytes [3, 8]. Although there is no characteristic panel of antibodies that are pathognomonic for cholangiocarcinoma, tumors of biliary epithelial origin tend to express CK7 and sometimes CK20 although they lack CDX2 expression [7, 8]. These immunohistochemical markers can thus be helpful in initially narrowing the diagnosis.…”

“…Skin metastases from primary hepatobiliary malignancies, such as hepatocellular carcinoma (HCC) or cholangiocarcinoma, are exceedingly rare events described mostly in case reports [3–7]. It is estimated that cutaneous metastasis from HCC represents only 0.2%–2.7% of all cutaneous metastases [8], and metastatic lesions to the skin secondary to cholangiocarcinoma are even more infrequent with less than thirty documented reports in the literature [7].…”

“…It is estimated that cutaneous metastasis from HCC represents only 0.2%–2.7% of all cutaneous metastases [8], and metastatic lesions to the skin secondary to cholangiocarcinoma are even more infrequent with less than thirty documented reports in the literature [7]. …”