title: Metastatic hepatocellular carcinoma of the breast, simulating gynecomastia: diagnosis by fine-needle aspiration biopsy.
abstract: Hepatocellular carcinoma (HCC) may uncommonly present with distant metastasis in the absence of a documented neoplasm in the liver. The authors herein describe the case of a 60-year-old man with cirrhosis who developed unilateral enlargement of the breast and a subareolar mass. This problem was clinically thought to represent gynecomastia, but a mammary fine-needle aspiration biopsy demonstrated a malignant epithelial neoplasm composed of large granular amphophilic cells. Bile pigment was visualized in the tumor on aspirate smears and cell block preparations; immunostains showed reactivity for cytokeratin and alpha-fetoprotein, but there was no positivity for epithelial membrane antigen, gross cystic disease fluid protein-15, vimentin, estrogen receptors, progesterone receptors, or S100 protein. These results indicated a diagnosis of metastatic HCC, which was subsequently confirmed by computed tomography of the abdomen.
authors.affiliation: Department of Pathology, General City Hospital, Benevento, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Nappi
authors.forename: G
authors.initials: G
authors.lastname: Ferrara
authors.forename: G
authors.initials: G
authors.lastname: Ianniello
authors.forename: M R
authors.initials: MR
authors.lastname: Wick
mesh_terms: D015415:Biomarkers; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000473:pathology* / Q000556:secondary*; D003937:Diagnosis, Differential; D006177:Gynecomastia / Q000473:pathology*; D006801:Humans; D007124:Immunoenzyme Techniques; D008113:Liver Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers