Hepatocellular carcinoma – an unusual metastatic presentation on the chest wall

Abstract

Hepatocellular carcinoma (HCC) is a common malignancy for which chronic hepatitis B infection has been defined as the most common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain. Metastases to the chest wall have been reported rarely. We report a patient with HCC who presented with an isolated metastatic mass on the right chest wall. Metastasis of HCC should be included in the differential diagnosis of rapidly growing lesions in unusual locations, particularly in patients with chronic liver disease and HBsAg-positive patients, even if a primary tumor cannot be radiologically identified.

Hepatocellular carcinoma presenting as a chest wall mass – An unusual case diagnosed on cytology with review of literature

“…Literature reports seven such cases, of which one was diagnosed on cytology. [2][3][4][6][7][8][9] Most of these cases had metastatic HCC from a clinically and radiologically unrecognized liver mass. In the present case, USG revealed a lesion in the right lobe of liver.…”

“…The described case presented solely with an isolated chest wall swelling, diagnosed on FNAC. Literature reports seven such cases, of which one was diagnosed on cytology 2–4,6–9 . Most of these cases had metastatic HCC from a clinically and radiologically unrecognized liver mass.…”

“…Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and the sixth most common malignancy worldwide 1,2 . The usual presentation includes anorexia, malaise, abdominal pain, ascites, and liver enlargement 3 . Metastasis typically occurs in patients with advanced stages of the disease, and the most common sites include lungs, lymph nodes, bone, adrenal gland, pancreas, kidney and spleen 4 .…”

“…Ultrasonography (USG) of the chest wall detected a hypoechoic soft tissue lesion overlying the left fifth rib at the costochondral junction. The lesion was vascular, measured 4.3 Â 2.8 Â 2.4 cm 3…”

CT of the paraumbilical and ensiform veins in patients with superior vena cava or left brachiocephalic vein obstruction

“…The paraumbilical veins have been implicated in the spread of hepatobiliary malignancy or infection to the falciform ligament, anterior abdominal wall and diaphragm [ 26 , 27 ]. They may also play a role in dissemination of hepatobiliary malignancy to unusual distant sites, bypassing the lung [ 28 , 29 ]. The venous spread of disease to the liver could conceivably occur in a reverse fashion, from the anterior thoracoabdominal wall, diaphragm or mediastinum.…”