A 70-year-old woman was referred to our clinic due to a hard, mobile tapered nodular tumor of well-defined limits, 4 cm in maximum diameter, located in the subxiphoid region.
The lesion had appeared as a small pink papule 6 months before and its growth had been fast and progressive, until it became slightly painful.
The patient had a history of diffuse hepatocellular carcinoma with a 5 cm nodule in the left liver lobe and multiple nodules in the right liver lobe, all of them on liver cirrhosis due to hepatitis C virus. CT scan had been diagnosed 15 months prior.
The extension and size of the tumor contraindicated the surgical intervention, so we considered the treatment with suprasellar chemoembolizations, using a common right femoral artery approach, using lipiodol, cisplatin and embo.
Current laboratory tests showed LDH 482 IU/L, GOT 182 IU/L, GPT 166 IU/L, a-fetoprotein 324.5 ng/mL.
Abdominal CT showed a solid lesion of 3.5 cm located in subcutaneous cellular tissue, without intra-abdominal continuity, with well-defined limits, isodense with the liver, which was not observed in previous tumor controls.
Also, multiple lesions in previously known segments II, III, IV and VII were visualized.
The location of the subcutaneous lesion coincided with the puncture path for segment II biopsy performed months earlier.
No metastatic disease was demonstrated elsewhere.
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With the diagnosis of subcutaneous metastasis of hepatocellular carcinoma, exeresis of the lesion was indicated, which was performed under general anesthesia without complications.
Macroscopically, the surgical specimen consisted of a cutaneous ellipse with abundant subcutaneous tissue, containing an ulcerated, raised, non-ulcerated tumor, occupying an area of 5 x 2.5 x 2 cm, well-defined hemorrhagic skin.
Microscopically, it was observed that the tumor was located in the subcutaneous tissue adjacent to the reticular dermis, separated from it by a fibrous pseudocapsule.
It showed an expansive growth pattern.
It contained bundles and cords of hepatocytes of diverse size and morphology, with intensely eosinophilic cytoplasm, and hyperchroidal nuclei, of variable dimensions, with moderate pleomorphism.
Some mitotic figures were also observed.
Tumor cells showed immunoreactivity for alpha-fetoprotein and hepatocyte marker ("hepatocyte").
The proliferative index (percentage of Ki-67 positive cells) was high (> 20%).
Histological findings and immunohistochemical staining were practically identical to those of the original tumor.
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After surgery, the postoperative period was satisfactory and the patient continues to be treated by embolization of her liver disease.
