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Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It can be diagnosed at a late stage due to the lack of early symptom onset and its non-pathognomonic symptoms. Metastatic regions often include the lung, lymph nodes, bones, and adrenal glands. Soft tissue and central nervous system (CNS) metastases are extremely rare. The incidence of CNS metastasis ranges from 0.6% to 1.7%. Curative treatment is liver transplantation or resection in early stages. In advanced stages, local therapies include transarterial chemoembolization and radioembolization. Systemic treatments, such as sorafenib, regorafenib, ramucirumab, and nivolumab, are applied in the metastatic stage. We aimed to present with literature the case of HCC that was diagnosed incidentally and had rare metastasis of soft tissue and CNS and long-term overall survival.

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BackgroundLung involment is one of the extra-articular manifestations that is shown to be related to morbidity and mortality in Rheumatoid arthritis (RA).ObjectivesWe evaluated the progression of lung involvement in RA patients receiving biological treatment.MethodsEighty RA patients fulfilling ACR/EULAR classification criteria (2010) receiving biologics who had high-resolution computerised tomography (HRCT) of chest within 6 months of respiratory symptoms (cough/dyspnea) and/or any pathology in chest radiography were included. Warrick score, evaluating alveolitis and fibrosis, was calculated in RA patients by using HRCT of chest.ResultsThe demographics and clinical findings were summarised in table 1. In 29 RA patients with interstitial findings in HRCT of chest; 7 (24%) were regressed and 1 (4%) was progressed with biologic drugs. Findings of alveolitis and fibrosis were completely regressed in 2, only alveolitis component was completely regressed in 3 and partially in 2 patients. The patient who progressed had new findings of alveolitis (table 2). Twenty-one patients in whom Warrick scores did not change, 5 received rituximab (RTX) and 10 received TNF inhibitors (TNF-inh). The mean Warrick scores was improved after biologics (11,3±9 (3–30) vs 10,3±9 (0–30), p=0,035). The improvement in alveolitis scores was significant (2,1±1,6 vs 1,5±1,6, p=0,031) while fibrosis scores were not (9,2±7,7 vs 8,8±8). Initial and control Warrick scores were higher in RTX receivers (16±9 vs 9,2±8, p=0034 and 14,8±10,1 vs 8,4±8,1), but the improvement after biologics was not different.Abstract THU0225 – Table 1Demographics in Rheumatoid Arthritis PatientsAbstract THU0225 – Table 2Progression of Warrick Scores in Cases After BiologicsConclusionsThis study revealed an improvement in alveolitis after biologic drugs in RA patients. Fibrosis was not found to be effected by therapy. Lung lesions were improved in both RTX and TNF-inh groups.Disclosure of InterestNone declared