Hepatocellular carcinoma presenting as bone metastasis

Abstract

In a consecutive series of 395 patients with pathologically verified hepatocellular carcinoma, 20 patients (5%) had bone metastasis at initial presentation. Of these, 16 were men and four women ranging from 26 to 64 years of age (median, 50 years). The age, sex, hepatitis B surface antigen seropositivity, alpha-fetoprotein level, and frequency of associated cirrhosis were not statistically different from those in patients without initial bone metastasis. Initial presentation was usually the result of spinal lesion with neurologic compression, and chest wall or scalp mass. Metastasis most commonly involved spine and ribs, and occurred as osteolytic lesions or extrapleural mass. Computed tomography proved best for demonstrating an expansile soft tissue mass with bony destruction. Angiography showed hypervascular appearance over the destructive bone area. Treatment results were poor. The follow-up period ranged from 3 weeks to 14 months with a median survival of 5 months. The data suggested that hepatocellular carcinoma be ruled out in patients with osteolytic lesions.

An Unusual Case Report Of Hepatocellular Carcinoma Metastasis To The Chest Wall Presenting As Breast Lump

“…HCC metastases to bone are seen in 3.0-10.0% of HCC patients. [5][6][7][8][9][10] The common sites are vertebra, pelvis, ribs and skull. 11 The bony lesions due to metastatic HCC in our case was osteolytic.…”

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

“…The incidence of BMs in HCC patients has been reported to be relatively low; 2%-12.9% in clinical studies, and 7.3%-38.5% in patients with extrahepatic metastases (Table 1) [2, 3,5,[13][14][15][16] . However, BM incidences of 10.2% and 12.9% were reported by Katyal et al [15] and Fukutomi et al [3] , respectively, which are higher than previously reported rates.…”

“…The lower-thoracic and lumbar vertebrae are common sites for vertebral BMs [18] . The reported incidence of skull metastases varies widely; 3.5%-30% [4,7,8,14] . Radiographically, typical BMs from HCC appear as expansible, destructive findings with large soft-tissue masses [13] .…”

“…Radiographically, typical BMs from HCC appear as expansible, destructive findings with large soft-tissue masses [13] . Most BMs are osteolytic and thus detectable using CT [14,19] (Figure 1). However, HCC patients rarely exhibit either purely osteolytic or osteoblastic lesions [13,19] .…”

“…Soft-tissue masses are unique to BMs of HCC and have been observed in 39%-85.4% of patients [8,[18][19][20] . These Kuhlman et al [13] 1979-1985 300 22 (7.3) Liaw et al [14] 1983-1887 395 20 (5) Katyal et al [15] 1992-1997 403 148 (36.7) 41(10.2) 28 Fukutomi et al [3] 1978-1987 269 12 (4.5) 1988-1997 404 52 (12.9) Natsuizaka et al [5] 1995 soft-tissue masses can replace the normal bone matrix and exhibit expansive growth, frequently within the vertebral body. Paravertebral masses have been shown to grow inward to encapsulate and destroy the bone matrix [18] .…”