Hepatocellular carcinoma metastatic to skin: diagnostic utility of antihuman hepatocyte antibody in combination with albumin in situ hybridization

• Published in: Journal of cutaneous pathology Vol. 36; no. 2; pp. 262 - 266
• Main Authors: Wood, Angela J., Lappinga, Paul J., Ahmed, Iftikhar
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2009; Wiley-Blackwell
• Subjects: Aged; Albumins - biosynthesis; Albumins - immunology; Antibodies, Neoplasm - chemistry; Antibodies, Neoplasm - immunology; Biological and medical sciences; Carcinoma, Hepatocellular - immunology; Carcinoma, Hepatocellular - metabolism; Carcinoma, Hepatocellular - pathology; Dermatology; Diagnosis, Differential; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatocytes - immunology; Hepatocytes - metabolism; Humans; In Situ Hybridization - methods; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Proteins - biosynthesis; Neoplasm Proteins - immunology; RNA, Messenger - biosynthesis; RNA, Neoplasm - biosynthesis; Skin Neoplasms - immunology; Skin Neoplasms - metabolism; Skin Neoplasms - pathology; Skin Neoplasms - secondary; Tumors; Drug combination; Antibody; Dermatology; In situ; Albumin; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Hybridization; Metastasis; Anatomic pathology; Hepatocyte; Digestive diseases; Metastatic; Skin; Diagnosis; Cancer
• ISSN: 0303-6987; 1600-0560
• DOI: 10.1111/j.1600-0560.2008.01029.x

Background:  Cutaneous metastases from hepatic neoplasms are rare. Histologic features of hepatocellular carcinoma (HCC) are often poorly differentiated, hindering accurate diagnosis on routine examination by hematoxylin‐eosin stain. Antihuman hepatocyte antibody is highly sensitive for HCC but can be strongly expressed in other adenocarcinomas. Albumin in situ hybridization (ISH) is highly specific and sensitive for HCC; in combination with antihuman hepatocyte antibody, it has a diagnostic sensitivity approaching 100%. To our knowledge, the combination of antihuman hepatocyte antibody and albumin ISH has not previously been examined in the context of cutaneous HCC. Methods:  We present histologic findings and results of ancillary studies for three patients with metastatic HCC. These patients had a poorly differentiated cytokeratin‐positive cutaneous neoplasm. All three cases were evaluated with antihuman hepatocyte antibody and albumin ISH. Results:  Neoplastic cells were strongly positive for antihuman hepatocyte antibody, and ISH detected albumin messenger RNA in nearly 100% of the neoplastic cells in all three cases. Conclusions:  The combination of antihuman hepatocyte antibody and albumin ISH is highly sensitive and specific for HCC metastatic to skin and is useful in the differential diagnosis of a poorly differentiated cytokeratin‐positive neoplasm.