Abstract

A 47-year-old man presented with an approximately 1-year history of an erythematous, firm, shiny papule on the abdomen, at the site of a former percutaneous drain placed during liver transplant for spontaneous perihilar cholangiocarcinoma. Histopathologic exam of a punch biopsy specimen demonstrated multiple glandular structures with cytologically bland predominantly columnar epithelia and intraluminal mucin, on a background of desmoplastic dermal stroma, consistent with metastatic cholangiocarcinoma. Cholangiocarcinoma rarely metastasizes to skin, with less than one hundred reported cases. Approximately half of these cases occur at the site of percutaneous drain placement for biliary decompression, suggesting direct seeding from liver to skin via the drain. To our knowledge, this is the first reported patient with cutaneous metastasis of cholangiocarcinoma associated with percutaneous biliary drain placement at the time of liver transplant. This case suggests that the risk of direct seeding of neoplastic cells to skin along the drain may exist even when the primary tumor has been surgically removed immediately prior to drain placement.

Financial Disclosure:
No current or relevant financial relationships exist.