Case Report

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

Figure 2

(a) H&E staining of abdominal wall excisional biopsy showing nodules of tumor cells with intervening entrapped soft tissue. Tumor cells demonstrate large variation in size with moderate nuclear pleomorphism; many tumor cells show cytoplasmic clearing. (b) Tumor cells show strong focal cytoplasmic reactivity for HepPar-1 supporting a diagnosis of metastatic HCC. (c) H&E staining of punch biopsy of skin showing tumor cells in the dermis streaming in cords and trabeculae with occasional gland-like formations. Tumor cells are hyperchromatic with increased nuclear-to-cytoplasmic ratio. (d) Tumor cells highlighted by CK7 immunohistochemistry (brown), showing diffuse strong cytoplasmic reactivity. Tumor cells were also positive for EMA and focally positive for mucicarmine; CK20, HepPar-1, CDX-2, and PSA were negative. The immunoprofile (CK7(+), CK20(−), and HepPar-1(−)) supports biliary over hepatic origin but is not definitive.