Case and Research Letter
Cutaneous Metastasis From Hepatocellular Carcinoma After a Percutaneous Interventional Procedure
Metástasis cutánea de hepatocarcinoma tras procedimientos percutáneos
F.J. de León
, M.M. Blanes, M.P. Albares, L. Berbegal
Corresponding author
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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Blanes, M.P. Albares, L. Berbegal" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "de León" "email" => array:1 [ 0 => "fjlmarrero1@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Blanes" ] 2 => array:2 [ "nombre" => "M.P." "apellidos" => "Albares" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Berbegal" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis cutánea de hepatocarcinoma tras procedimientos percutáneos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 744 "Ancho" => 995 "Tamanyo" => 338353 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Excisional skin biopsy (hematoxylin-eosin, original magnification X40). Infiltration of the dermis and adipose tissue by hepatocellular carcinoma. Contact with the deep surgical margin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous metastases from hepatocellular carcinoma are very uncommon, and, according to one series, account for just 0.8% of all cutaneous metastases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Iatrogenic factors appear to be the most common cause and include needle tract seeding during percutaneous interventional procedures and surface seeding of tumor cells during surgery.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 35-year-old man with a history of chronic hepatitis C virus infection with progression to cirrhosis. He was subsequently diagnosed with hepatocellular carcinoma, which was treated with concomitant radiofrequency ablation and percutaneous ethanol injections. A year after treatment, the patient presented with a subcutaneous nodule in the right costal region (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The site of the lesion appeared to coincide with that of the radiofrequency needle tract. Computed tomography showed a large lesion consistent with progression of the hepatocellular carcinoma on the right abdominal wall, in addition to multiple intrahepatic metastatic masses (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 2</a>). Skin biopsy confirmed that the cutaneous lesion was a metastasis from the hepatocellular carcinoma (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 3</a>). Surgical treatment and chemoembolization were ruled out because of the size of the lesion. The patient was administered chemotherapy (sorafenib) and radiation therapy in the scar area, but died 5 months after diagnosis of the cutaneous metastasis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Percutaneous interventional procedures have a very important role in the management of hepatocellular carcinoma and are widely used in this setting.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The main procedures are fine-needle aspiration biopsy, percutaneous ethanol injections, and radiofrequency ablation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> These procedures are generally considered to be safe, and while various complications have been described, they are uncommon, can mostly be managed conservatively, and are associated with low mortality.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Needle tract seeding in hepatocellular carcinoma is an exception. While very rare, it can occur throughout follow-up and alters prognosis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Needle-tract implantations generally appear as a single or few round or oval nodules along the tract of the needle, which extends from the intraperitoneal region to the skin or subcutaneous tissues through the abdominal or intercostal muscles.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The overall incidence of tumor seeding (considering all techniques) ranges from 0.5% to 1%, with rates varying slightly according to the technique used.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In most studies, the reported incidence is less than 2%.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Several hypotheses have been proposed to explain how tumor cells are disseminated along the needle tract.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The first is that viable tumor cells adhere to the needle and break off as this is being removed. The second is that tumor cells might be carried to the surface of the skin during the reflux of blood or other fluids up the needle tract, and the third is that tumor cells might enter the tract due to a sudden increase in intratumoral pressure, as commonly occurs during radiofrequency ablation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A conservative approach is taken in most cases, as many patients are already in the terminal stages of their disease when the metastases are detected. Surgical excision, however, is sometimes performed. When this is not possible, because of advanced disease, low performance status, or other reasons, radiation therapy appears to be a reasonable alternative.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, needle tract seeding in percutaneous interventional procedures are very rare, but are the most common cause of cutaneous metastases from hepatocellular carcinoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de León FJ, Blanes MM, Albares MP, Berbegal L. Metástasis cutánea de hepatocarcinoma tras procedimientos percutáneos. Actas Dermosifiliogr. 2015;106:440–441.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 663 "Ancho" => 995 "Tamanyo" => 87517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous nodule on the right side.</p>" ] ] 1 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 728 "Ancho" => 996 "Tamanyo" => 57631 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging scan (gadolinium-enhanced fat-saturated T1-weighted image). Metastastic lesion on the right abdominal wall adjacent to the lower pole of the liver (*) with cutaneous involvement (**).</p>" ] ] 2 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 744 "Ancho" => 995 "Tamanyo" => 338353 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Excisional skin biopsy (hematoxylin-eosin, original magnification X40). Infiltration of the dermis and adipose tissue by hepatocellular carcinoma. 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Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3348/kjr.2008.9.3.268" "Revista" => array:6 [ "tituloSerie" => "Korean J Radiol" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "268" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18525230" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.C. Tung" 1 => "Y.J. Huang" 2 => "S.W. Leung" 3 => "F.Y. Kuo" 4 => "H.D. Tung" 5 => "J.H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2006.01399.x" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "192" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17311613" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000005/v1_201506041458/S1578219015001067/v1_201506041458/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000005/v1_201506041458/S1578219015001067/v1_201506041458/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001067?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 13 | 19 |
| 2024 October | 64 | 53 | 117 |
| 2024 September | 51 | 20 | 71 |
| 2024 August | 92 | 58 | 150 |
| 2024 July | 75 | 49 | 124 |
| 2024 June | 79 | 35 | 114 |
| 2024 May | 76 | 35 | 111 |
| 2024 April | 72 | 31 | 103 |
| 2024 March | 60 | 28 | 88 |
| 2024 February | 57 | 22 | 79 |
| 2024 January | 53 | 27 | 80 |
| 2023 December | 45 | 19 | 64 |
| 2023 November | 57 | 27 | 84 |
| 2023 October | 70 | 21 | 91 |
| 2023 September | 61 | 33 | 94 |
| 2023 August | 40 | 16 | 56 |
| 2023 July | 42 | 56 | 98 |
| 2023 June | 56 | 21 | 77 |
| 2023 May | 58 | 28 | 86 |
| 2023 April | 41 | 14 | 55 |
| 2023 March | 55 | 22 | 77 |
| 2023 February | 51 | 23 | 74 |
| 2023 January | 57 | 16 | 73 |
| 2022 December | 46 | 33 | 79 |
| 2022 November | 24 | 30 | 54 |
| 2022 October | 30 | 28 | 58 |
| 2022 September | 28 | 32 | 60 |
| 2022 August | 21 | 33 | 54 |
| 2022 July | 18 | 22 | 40 |
| 2022 June | 16 | 23 | 39 |
| 2022 May | 23 | 30 | 53 |
| 2022 April | 43 | 35 | 78 |
| 2022 March | 34 | 31 | 65 |
| 2022 February | 23 | 27 | 50 |
| 2022 January | 43 | 32 | 75 |
| 2021 December | 27 | 35 | 62 |
| 2021 November | 37 | 43 | 80 |
| 2021 October | 66 | 46 | 112 |
| 2021 September | 41 | 29 | 70 |
| 2021 August | 31 | 21 | 52 |
| 2021 July | 40 | 24 | 64 |
| 2021 June | 36 | 25 | 61 |
| 2021 May | 31 | 26 | 57 |
| 2021 April | 65 | 65 | 130 |
| 2021 March | 49 | 19 | 68 |
| 2021 February | 38 | 16 | 54 |
| 2021 January | 40 | 15 | 55 |
| 2020 December | 33 | 16 | 49 |
| 2020 November | 17 | 15 | 32 |
| 2020 October | 11 | 6 | 17 |
| 2020 September | 26 | 14 | 40 |
| 2020 August | 22 | 18 | 40 |
| 2020 July | 40 | 15 | 55 |
| 2020 June | 34 | 27 | 61 |
| 2020 May | 30 | 20 | 50 |
| 2020 April | 30 | 18 | 48 |
| 2020 March | 22 | 16 | 38 |
| 2020 February | 7 | 7 | 14 |
| 2020 January | 4 | 11 | 15 |
| 2019 December | 8 | 4 | 12 |
| 2019 November | 4 | 2 | 6 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 6 | 0 | 6 |
| 2019 July | 8 | 5 | 13 |
| 2019 June | 4 | 28 | 32 |
| 2019 May | 8 | 36 | 44 |
| 2019 April | 2 | 5 | 7 |
| 2019 March | 2 | 8 | 10 |
| 2019 February | 4 | 3 | 7 |
| 2019 January | 3 | 0 | 3 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 33 | 1 | 34 |
| 2018 January | 54 | 4 | 58 |
| 2017 December | 66 | 7 | 73 |
| 2017 November | 33 | 5 | 38 |
| 2017 October | 25 | 3 | 28 |
| 2017 September | 14 | 2 | 16 |
| 2017 August | 22 | 16 | 38 |
| 2017 July | 16 | 9 | 25 |
| 2017 June | 25 | 9 | 34 |
| 2017 May | 25 | 8 | 33 |
| 2017 April | 18 | 7 | 25 |
| 2017 March | 24 | 23 | 47 |
| 2017 February | 14 | 7 | 21 |
| 2017 January | 14 | 7 | 21 |
| 2016 December | 25 | 11 | 36 |
| 2016 November | 39 | 15 | 54 |
| 2016 October | 33 | 9 | 42 |
| 2016 September | 0 | 7 | 7 |
| 2016 July | 5 | 0 | 5 |
| 2016 June | 10 | 0 | 10 |
| 2016 May | 7 | 1 | 8 |
| 2016 April | 2 | 13 | 15 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 3 | 1 | 4 |
| 2016 January | 6 | 2 | 8 |
| 2015 December | 8 | 1 | 9 |
| 2015 October | 0 | 2 | 2 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 6 | 1 | 7 |
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