title: Hepatocellular carcinoma metastatic to skin: diagnostic utility of antihuman hepatocyte antibody in combination with albumin in situ hybridization.
abstract: BACKGROUND
  Cutaneous metastases from hepatic neoplasms are rare. Histologic features of hepatocellular carcinoma (HCC) are often poorly differentiated, hindering accurate diagnosis on routine examination by hematoxylin-eosin stain. Antihuman hepatocyte antibody is highly sensitive for HCC but can be strongly expressed in other adenocarcinomas. Albumin in situ hybridization (ISH) is highly specific and sensitive for HCC; in combination with antihuman hepatocyte antibody, it has a diagnostic sensitivity approaching 100%. To our knowledge, the combination of antihuman hepatocyte antibody and albumin ISH has not previously been examined in the context of cutaneous HCC.
  
  
  METHODS
  We present histologic findings and results of ancillary studies for three patients with metastatic HCC. These patients had a poorly differentiated cytokeratin-positive cutaneous neoplasm. All three cases were evaluated with antihuman hepatocyte antibody and albumin ISH.
  
  
  RESULTS
  Neoplastic cells were strongly positive for antihuman hepatocyte antibody, and ISH detected albumin messenger RNA in nearly 100% of the neoplastic cells in all three cases.
  
  
  CONCLUSIONS
  The combination of antihuman hepatocyte antibody and albumin ISH is highly sensitive and specific for HCC metastatic to skin and is useful in the differential diagnosis of a poorly differentiated cytokeratin-positive neoplasm.
authors: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. wood.angela@mayo.edu
authors: Angela J
authors: AJ
authors: Wood
authors: Paul J
authors: PJ
authors: Lappinga
authors: Iftikhar
authors: I
authors: Ahmed
mesh_terms: D000368:Aged; D000418:Albumins / Q000096:biosynthesis / Q000276:immunology; D000912:Antibodies, Neoplasm / Q000737:chemistry* / Q000276:immunology; D006528:Carcinoma, Hepatocellular / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D022781:Hepatocytes / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D017403:In Situ Hybridization / Q000379:methods; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009363:Neoplasm Proteins / Q000096:biosynthesis / Q000276:immunology; D012333:RNA, Messenger / Q000096:biosynthesis; D012334:RNA, Neoplasm / Q000096:biosynthesis; D012878:Skin Neoplasms / Q000276:immunology / Q000378:metabolism / Q000473:pathology* / Q000556:secondary
chemical_list: D000418:Albumins; D000912:Antibodies, Neoplasm; D009363:Neoplasm Proteins; D012333:RNA, Messenger; D012334:RNA, Neoplasm