Extrahepatic metastases as initial manifestations of hepatocellular carcinoma: an Egyptian experience

Abstract

BackgroundThe incidence of hepatocellular carcinoma (HCC) in Egypt has markedly increased in the recent years, mainly due to the high incidence of hepatitis C virus (HCV) infection. Consequently, the frequency of metastatic HCC has also increased. The current study presents a series of 47 patients who were initially diagnosed as metastatic HCC.MethodsForty seven patients with the diagnosis of extrahepatic metastases of HCC at initial presentation were included in the study. The sites of metastases were bones (17), lymph nodes (9), soft tissue (7), omentum (7), maxillary sinus (2), adrenal gland (2), brain (2) and skin (1). The diagnosis of metastatic HCC was confirmed by immunohistochemistry.ResultsThe patients included in the study were 38 males and 9 females, ranging from 40 to 80 years (median 60 years). All patients were HCV-positive and 36 were cirrhotic. The diagnosis of primary HCC was confirmed in all cases, based on the typical hypervascular radiological features and/or high serum α-fetoprotein concentration, or histologic examination of liver biopsy.ConclusionMetastasis of HCC should be put into consideration when evaluating metastatic carcinoma with unknown primary. This is of particular importance in the Egyptian population who has the highest prevalence of HCV infection in the world.

Cutaneous manifestations in disorders of hepatobiliary system

“…Hepatic malignancies, especially hepatocellular carcinoma, can rarely have cutaneous manifestations such as cutaneous metastasis, pityriasis rotunda (round-to-oval ichythyotic patches), porphyria cutanea tarda-like and dermatomyositis-like presentation. [ 2 26 27 ] In our study also, we noticed pityriasis rotunda and small plaque parapsoriasis (digitate subtype) in one patient each with hepatocellular carcinoma. Basal cell carcinoma (noduloulcerative type) was also noticed in one patient with hepatocellular carcinoma.…”

Advanced‐stage hepatocellular carcinoma presenting without radiographic liver lesions

“…This made confirming HCC important due to the implications on management. Interestingly, in all the reported cases of extrahepatic HCC, without liver primaries, the subjects were all hepatitis C positive , unlike our patient. Other cases reported of unusual presentations of HCC have had some unusual finding on liver imaging corresponding with the time of or prior to diagnosis, unlike our patient who developed lesions after confirmed diagnosis and treatment had been initiated .…”

“…He also presented with GI hemorrhage each time, making him an even higher risk patient. He did have a risk factor of alcohol abuse, alcoholic hepatitis, and alcoholic steatosis, which are associated with HCC, even in the absence of cirrhosis . This made confirming HCC important due to the implications on management.…”

Clinicopathological features and differential diagnosis of hepatocellular carcinoma in extrahepatic metastases

“…The initial aim of this study was to characterize a relatively large number of patients who presented as extrahepatic metastases of HCC, some of which initially manifested as metastases before the primary HCC were confirmed. Most of such reported cases were described in case reports or case series except for 5 studies [13–16] (Table 7). The current study included 195 patients from China mainland, most of whom were HBV positive.…”