Metastatic hepatocellular carcinoma with CD138 positivity: An unusual mimic of multiple myeloma?

Abstract

CD138 is a monoclonal anti-syndecan-1 antibody that is often used to identify plasma cells in the bone marrow of patients with multiple myeloma (MM). Several carcinomas may also express CD138 including prostate, colon, renal cell, and hepatocellular carcinoma (HCC). We report a case of metastatic HCC that presented as a soft tissue mass on the back of a 67-year-old male. Based on the clinical and radiologic findings, MM was strongly suspected. In addition, fine-needle aspiration biopsy (FNAB) of the mass revealed neoplastic cells that were positive for CD138, both by immunohistochemistry (IHC) and flow cytometry. The cytomorphologic features however did not support a diagnosis of MM, but were consistent with metastatic HCC. Our case highlights the potential problems that may arise by over-reliance on IHC and flow cytometry. Careful morphologic assessment as well as clinical and radiologic correlation are very important when evaluating any CD138-positive neoplasm. This approach should improve diagnostic accuracy and reduce the risk of erroneous interpretation of aberrant IHC results. In addition, we examined the expression of CD138 in known cases of HCC.

Syndecan-1 Promotes Hepatocyte-Like Differentiation of Hepatoma Cells Targeting Ets-1 and AP-1

“…The degree of syndecan-1 loss in carcinomas often correlates with histological grade and indicates poor prognosis, as shown in head and neck [ 38 , 39 , 40 ], hepatocellular [ 13 , 14 ], colorectal [ 41 , 42 , 43 , 44 ], cervical [ 45 ], pancreatic [ 46 ], renal carcinomas [ 47 ], and bladder [ 48 ] cancers. Intriguingly, strong expression of syndecan-1 can also confer aggressive behavior to some tumor types as reported in dedifferentiated thyroid [ 49 ], poorly differentiated prostate [ 50 , 51 ], high grade breast [ 52 , 53 ], high grade ovarian [ 54 , 55 ], and high grade hepatocellular carcinomas [ 12 ].…”

“…Normal hepatocytes also express syndecan-1 on their basolateral surface facing the space of Disse [ 7 , 8 , 9 , 10 ]. In HCC, the normal sinusoidal and lateral localization pattern of syndecan-1 changes to a more uniform, honeycomb-like membrane distribution, with occasional cytoplasmic and nuclear positivity [ 9 , 10 , 11 , 12 ]. Syndecan-1 levels are found upregulated in HCCs that develop in a cirrhotic liver [ 10 ].…”

A BAFfling liver aspirate: Metastatic high grade SMARCA4 deficient undifferentiated gastroesophageal junction carcinoma masquerading as a hematolymphoid malignancy

“…The diagnosis of these hematolymphoid neoplasms relies heavily on immunophenotyping by flow cytometry or immunohistochemistry and cytogenetics; some of the entities considered in the differential diagnosis are also characterized by characteristic associations with Epstein Barr virus and/or HHV8. It has to be kept in mind that some of the antibodies used in the immunophenotyping of hematolymphoid malignancies, like CD138 and PAX5 are not specific for plasmacytic and respectively B‐cell lineage, and can be also be found in some carcinomas, including poorly differentiated and neuroendocrine carcinomas . Neuroendocrine carcinomas also enter the differential diagnosis, since they frequently have a dispersed cell pattern and are composed of relatively uniform cells with plasmacytoid or even rhabdoid features and high nucleus: cytoplasm ratios.…”

Extramedullary multiple myeloma involving the liver and periportal lymph node, diagnosed by EUS‐FNA in a patient with cirrhosis

“…Another important point worth mentioning here that CD 138 is not only a plasma cell marker but also can be positive in epithelial cells, such as hepatocytes in our case (Figure B, black arrow). Additional pan‐cytokeratin immunohistochemical stain in the cell block showed positive in the hepatocytes and negative in the neoplastic plasma cells, which supported the diagnosis.…”