Korean J Hepatol.  2012 Mar;18(1):89-93. 10.3350/kjhep.2012.18.1.89.

A case of isolated metastatic hepatocellular carcinoma arising from the pelvic bone

• Jung KS
• Park KH
• Chon YE
• Lee SR
• Park YN
• Lee DY
• Seong JS
• Park JY

• KMID: 1372656
• DOI: http://doi.org/10.3350/kjhep.2012.18.1.89

Abstract

Reports of metastatic hepatocellular carcinoma (HCC) without a primary liver tumor are rare. Here we present a case of isolated HCC that had metastasized to the pelvic bone without a primary focus. A 73-year-old man presented with severe back and right-leg pain. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed a huge mass on the pelvic bone (13x10 cm). He underwent an incisional biopsy, and the results of the subsequent histological examination were consistent with metastatic hepatocellular carcinoma. The tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1, and glypican-3, and negative for CD56, chromogranin A, and synaptophysin on immunohistochemical staining. Examination of the liver by CT, MRI, positron-emission tomography scan, and angiography produced no evidence of a primary tumor. Radiotherapy and transarterial chemoembolization were performed on the pelvic bone, followed by systemic chemotherapy. These combination treatments resulted in tumor regression with necrotic changes. However, multiple lung metastases developed 1 year after the treatment, and the patient was treated with additional systemic chemotherapy.

Keyword

Hepatocellular carcinoma; Pelvic bone; Metastasis; Radiotherapy; Transarterial chemoembolization

MeSH Terms

Aged
Bone Neoplasms/*diagnosis/*pathology/radiotherapy
Carcinoma, Hepatocellular/*pathology/radiography/*secondary
Chemoembolization, Therapeutic
Combined Modality Therapy
Glypicans/metabolism
Humans
Keratin-1/metabolism
Keratin-3/metabolism
Liver Neoplasms/*pathology/radiography/*secondary
Magnetic Resonance Imaging
Male
Paraffin/metabolism
Pelvic Bones/*pathology/radiography
Positron-Emission Tomography
Tomography, X-Ray Computed