Liu Jin, Cao Gang, Zhang Genshan, Liu Shuyi, Shi Daqun
Department of Interventional Therapy, The First People's Hospital of Lianyungang, Lianyungang, China.
J Gastrointest Oncol. 2023 Jun 30;14(3):1643-1649. doi: 10.21037/jgo-23-336. Epub 2023 Jun 25.
Reactive cutaneous capillary endothelial proliferation (RCCEP) is a common adverse event of camrelizumab in the treatment of advanced hepatocellular carcinoma. Facial skin metastasis is an exceptionally uncommon occurrence in hepatocellular carcinoma (HCC). It can be easily mistaken for a prevalent complication known as RCCEP, particularly when it manifests as a persistently enlarging tumor-like mass. This case report highlights a prototypical instance where a metastasis in the nasal alar region of HCC was mistakenly diagnosed as RCCEP during immunotherapy. The findings of this report hold significant clinical value in guiding the management of larger RCCEP lesions encountered during immunotherapy.
In this case, the patient is a male with a history of hepatitis B. In October 2015, he was diagnosed with HCC. In April 2020, he commenced treatment with ramucirumab (200 mg every 3 weeks) as tumor progression. However, during the third treatment cycle, the patient experienced RCCEP, predominantly affecting the head, neck, trunk, and limbs. To address this, sequential administration of apatinib was initiated, resulting in the gradual regression of RCCEP in these areas. Unfortunately, the metastatic lesion in the nasal alar region continued to grow, exhibiting a tumor-like appearance. On January 25, 2021, surgical resection was performed to remove the nasal alar lesion, and subsequent pathological examination confirmed it as a liver metastasis. Post-surgery, radiation therapy was administered to effectively manage the remaining lesion in the nasal alar region. Importantly, the treatment of the nasal alar metastasis did not hinder the comprehensive management of HCC. The patient obtained excellent curative effect.
During the course of immunotherapy for HCC, the emergence of a larger RCCEP lesion that does not show signs of regression even with vigorous treatment raises the suspicion of skin metastasis. It is difficult to distinguish metastatic tumor on the skin from morule- and tumor-like RCCEP that does not easily resolve. To obtain a definitive diagnosis, an early pathological biopsy is crucial. If confirmed as a metastatic tumor, prompt consideration should be given to implementing curative surgical resection.
反应性皮肤毛细血管内皮增生（RCCEP）是卡瑞利珠单抗治疗晚期肝细胞癌时常见的不良事件。面部皮肤转移在肝细胞癌（HCC）中极为罕见。它很容易被误诊为一种常见的并发症，即RCCEP，尤其是当它表现为持续增大的肿瘤样肿块时。本病例报告突出了一个典型案例，即HCC患者鼻翼区域的转移灶在免疫治疗期间被误诊为RCCEP。本报告的研究结果对于指导免疫治疗期间遇到的较大RCCEP病变的处理具有重要临床价值。
本病例患者为一名有乙肝病史的男性。2015年10月，他被诊断为HCC。2020年4月，由于肿瘤进展，他开始接受雷莫西尤单抗治疗（每3周200mg）。然而，在第三个治疗周期中，患者出现了RCCEP，主要累及头、颈、躯干和四肢。为解决这一问题，开始序贯使用阿帕替尼，导致这些部位的RCCEP逐渐消退。不幸的是，鼻翼区域的转移灶持续增大，呈现出肿瘤样外观。2021年1月25日，对鼻翼病变进行了手术切除，随后的病理检查证实为肝转移。术后，进行了放射治疗以有效处理鼻翼区域的残留病变。重要的是，鼻翼转移灶的治疗并未妨碍HCC的综合管理。患者获得了良好的疗效。
在HCC免疫治疗过程中，即使经过积极治疗仍未出现消退迹象的较大RCCEP病变的出现，应怀疑为皮肤转移。皮肤转移性肿瘤很难与不易消退的桑葚样和肿瘤样RCCEP相鉴别。为获得明确诊断,早期病理活检至关重要。如果确诊为转移性肿瘤，应迅速考虑实施根治性手术切除。
