Case Number : Case 1188 - 12th January Posted By: Guest

A suspected epidermal origin is perceived in images 2 and 4, if this is the case, porocarcinoma comes first. If no epidermal connection, will like to exclude metastatic adenocarcinoma.

Agree, I suspect from primary in stomach

My first impression is metastatic adenocarcinoma. Nuclear pleomorphism is too high for a tumor from prostate and the lack of intracytoplasmatic mucin makes gastrointestinal origin less likely, so lung must be considered.

Metastatic adenocarcinoma.

So it is metastatic hepatocellular carcinoma

Agree with metastatic carcinoma. Favor metastatic colon adenocarcinoma at first glance.

[size=4]With positive granular staining for HSA, the differential diagnosis may swing in favor of metastatic pseudoglandular hepatocellular carcinoma, although [/size][size=4]HSA (hepatocyte "specific" antigen), despite the name, is not that specific...it can deceitfully stain positive in cholangiocarcinoma, colonic [/size][size=4]adenocarcinoma and gastric adenocarcinoma. Additional stains like CK7, CK20, AFP, etc. as part of a panel can separate these differential possibilities.[/size]

[size=2]Hep Par 1 Antibody Stain for the Differential Diagnosis of Hepatocellular Carcinoma: 676 Tumors Tested Using Tissue Microarrays and Conventional Tissue Sections. [/size][i][size=2]Mod Pathol 2003;16(2):137–144[/size][/i]
[size=2] [url="http://www.nature.com/modpathol/journal/v16/n2/full/3880729a.html"]http://www.nature.co...l/3880729a.html[/url][/size][size=2] (Free Full Article link)[/size]

Metastatic carcinoma, be it adeno- or hepatocellular.

Thank Dr Hurt for such an interesting case. I agree with all the discussions above. But as for the primary origin of the tumor, per your staining results that the CK 7 is strongly postive are rarely seen In hepatocellular carcinoma which is often CK7 and CK20 negative tumor . Like Dr Davie mentioned, Hepar 1 is not specific for hepatocellular carcinoma. I think now there is a more specific marker for hepatocellular carcinoma called Glypican 3 if you want confirm it. Just don't like the strong CK7 positivity here for considering hepatocellular carcinoma as primary.