J Korean Orthop Assoc.  2019 Jun;54(3):276-280. 10.4055/jkoa.2019.54.3.276.

Unusual Semimembranosus Muscle Metastasis from Hepatocellular Carcinoma

• Kim SH
• Kim MW
• Kim JH
• Wang L

• KMID: 2450148
• DOI: http://doi.org/10.4055/jkoa.2019.54.3.276

Abstract

Hepatocellular carcinoma is one of the most common cancers worldwide. Extrahepatic metastasis commonly occur in the lung, lymph, nodes, bone, and adrenal glands. On the other hand, a metastasis of hepatocellular carcinoma to the skeletal muscle is rare. A 42-year-old woman presented for evaluation of a palpable mass with tenderness in her right thigh area. She has been diagnosed with hepatocellular carcinoma and pulmonary metastasis seven years ago and has received treatment. We performed incisional biopsy with suspicion of hepatocellular carcinoma metastasis from imaging studies and blood test results. The patient was finally diagnosed with metastasis of hepatocellular carcinoma in the semimembranosus muscle and treated by extensive resection. We report this case with a review of the relevant literature.

Keyword

semimembranosus muscle; hepatocellular carcinoma; metastasis

MeSH Terms

Adrenal Glands
Adult
Biopsy
Carcinoma, Hepatocellular*
Female
Hand
Hematologic Tests
Humans
Lung
Muscle, Skeletal
Neoplasm Metastasis*
Thigh

Figure

• 

  Figure 1. (A) Ultrasonography image shows a well-defined, heterogeneous echoic mass, located in the semimembranosus muscle. (B) Doppler image shows marked hypervascularity with the tumor.

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  Figure 2. (A) Axial T1-weighted magnetic resonance imaging (MRI) shows a lobulated soft tissue mass of slightly high signal intensity within the semimembranosus muscle. (B) Coronal T2-weighted MRI shows a heterogeneous signal intense mass, which was not observed to communicate with the other muscle or soft tissue.

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  Figure 3. Microscopic findings of metastatic hepatocellular carcinoma in semimembranosus muscle tissue. (A, B) The broad sheets of hepatocellular carcinoma cells invade the skeletal muscle tissue (A: H&E, ×20, B: H&E, ×50). (C) Clusters of atypical hepatocytes (H&E, ×200). (D) The tumor cells show diffuse immunoreactivity for a-fetoprotein (AFP) (immunohistochemistry for AFP, ×200). (E) Immunohistochemical staining for the hepatocyte-specific antigen was positive (immunohistochemistry for the hepatocyte-specific antigen, ×200).

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  Figure 4. Gross specimen of the excised mass, measuring 7.3×5.7×4.8 cm in size.

Reference

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