Korean J Gastroenterol.  2015 Jul;66(1):50-54. 10.4166/kjg.2015.66.1.50.

Hepatocellular Carcinoma with Cervical Spine and Pelvic Bone Metastases Presenting as Unknown Primary Neoplasm

Affiliations
  • 1Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. befamiliar@naver.com
  • 2Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

The occurrence of hepatocellular carcinoma (HCC) is closely associated with viral hepatitis or alcoholic hepatitis. Although active surveillance is ongoing in Korea, advanced or metastatic HCC is found at initial presentation in many patients. Metastatic HCC presents with a hypervascular intrahepatic tumor and extrahepatic lesions such as lung or lymph node metastases. Cases of HCC presenting as carcinoma of unknown primary have been rarely reported. The authors experienced a case of metastatic HCC in a patient who presented with a metastatic bone lesion but no primary intrahepatic tumor. This case suggests that HCC should be considered as a differential diagnosis when evaluating the primary origin of metastatic carcinoma.

Keyword

Hepatocellular carcinoma; Neoplams, unknown primary; Neoplasm metastasis

MeSH Terms

Antineoplastic Agents/therapeutic use
Bone Neoplasms/*diagnosis/diagnostic imaging/secondary
Carcinoma, Hepatocellular/*diagnosis/drug therapy
Cervical Cord/pathology
Chemoembolization, Therapeutic
Gamma Rays
Humans
Liver Neoplasms/*diagnosis/drug therapy
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasms, Unknown Primary/pathology
Niacinamide/analogs & derivatives/therapeutic use
Pelvic Bones/pathology
Phenylurea Compounds/therapeutic use
Tomography, X-Ray Computed
Antineoplastic Agents
Niacinamide
Phenylurea Compounds

Figure

  • Fig. 1. Cervical MRI shows a 3 cm sized mass located at C5 spine (arrow).

  • Fig. 2. Abdomen CT scan shows a 7.6 cm sized hypervascular mass at the right iliac bone (arrow).

  • Fig. 3. Biopsy specimen of the iliac bone. H&E stain shows round, eosinophilic cytoplasm-rich cells with a trabecular arrangement, suggestive of hepatocellular carcinoma (A, ×100; B, ×400). The tumor cells showed focally positive immunoreactivity for hepatocyte surface antigen (C) and CD10 (D) with a canalicular staining pattern (arrows).

  • Fig. 4. A hypervascular tumor mass on the iliac bone (transarterial chemoembolization).

  • Fig. 5. Abdomen CT scan after 2 months of sorafenib shows partial regression of the tumor mass (arrows).


Cited by  1 articles

A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass
Min Jung Kwon, Soo Hyung Ryu, Soo Yeon Jo, Chul Hoon Kwak, Won Jae Yoon, Jeong Seop Moon, Hye Kyung Lee
Korean J Gastroenterol. 2016;68(6):321-325.    doi: 10.4166/kjg.2016.68.6.321.


Reference

References

1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Prediction of cancer incidence and mortality in Korea, 2013. Cancer Res Treat. 2013; 45:15–21.
Article
2. de Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol. 2012; 56(Suppl 1):S75–S87.
Article
3. Kummar S, Shafi NQ. Metastatic hepatocellular carcinoma. Clin Oncol (R Coll Radiol). 2003; 15:288–294.
Article
4. Fukutomi M, Yokota M, Chuman H, et al. Increased incidence of bone metastases in hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2001; 13:1083–1088.
Article
5. Natsuizaka M, Omura T, Akaike T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol. 2005; 20:1781–1787.
Article
6. Ahmad Z, Nisa AU, Uddin Z, Azad NS. Unusual metastases of hepatocellular carcinoma (hcc) to bone and soft tissues of lower limb. J Coll Physicians Surg Pak. 2007; 17:222–223.
7. Takahama J, Taoka T, Marugami N, et al. Hepatocellular carcinoma of the iliac bone with unknown primary. Skeletal Radiol. 2010; 39:721–724.
Article
8. Jung KS, Park KH, Chon YE, et al. A case of isolated metastatic hepatocellular carcinoma arising from the pelvic bone. Korean J Hepatol. 2012; 18:89–93.
Article
9. Hofmann HS, Spillner J, Hammer A, Diez C. A solitary chest wall metastasis from unknown primary hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2003; 15:557–559.
Article
10. Hyun YS, Choi HS, Bae JH, et al. Chest wall metastasis from unknown primary site of hepatocellular carcinoma. World J Gastroenterol. 2006; 12:2139–2142.
Article
11. Ahmad K, Sah P, Dhungel K, et al. An unusual case report of hepatocellular carcinoma metastasis to the chest wall presenting as breast lump. Nepal J Medi Sci. 2012; 1:138–140.
Article
12. Oquiñena S, Guillen-Grima F, Iñarrairaegui M, Zozaya JM, Sangro B. Spontaneous regression of hepatocellular carcinoma: a systematic review. Eur J Gastroenterol Hepatol. 2009; 21:254–257.
Article
13. Huz JI, Melis M, Sarpel U. Spontaneous regression of hepatocellular carcinoma is most often associated with tumour hypoxia or a systemic inflammatory response. HPB (Oxford). 2012; 14:500–505.
Article
14. Sasaki T, Fukumori D, Yamamoto K, Yamamoto F, Igimi H, Yamashita Y. Management considerations for purported spontaneous regression of hepatocellular carcinoma: a case report. Case Rep Gastroenterol. 2013; 7:147–152.
Article
15. Terracciano LM, Glatz K, Mhawech P, et al. Hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma: an immunohistochemical and molecular study of eight cases. Am J Surg Pathol. 2003; 27:1302–1312.
16. Lee JE, Bae SH, Choi JY, Yoon SK, You YK, Lee MA. Epirubicin, cisplatin, 5-FU combination chemotherapy in sorafenib-refractory metastatic hepatocellular carcinoma. World J Gastroenterol. 2014; 20:235–241.
Article
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr