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

• Hwang S
• Lee J
• Lee JM
• Hong SH
• Lee MA
• Chun HG
• Chun HJ
• Lee SH
• Jung ES

• KMID: 2373312
• DOI: http://doi.org/10.4166/kjg.2015.66.1.50

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

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

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

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  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).

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

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

Reference

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