Unusual presentation of a common tumor

Abstract

Hepatocellular carcinoma(HCC) is the most common primary malignant tumour of liver. It is 5th most common malignancy in males and 8th most common tumour in females. The patients of HCC may remain clinically asymptomatic or may present with abdominal pain, weight loss, malaise, fever, jaundice or ascitis. HCC is a highly malignant tumor with frequent extrahepatic metastasis. The most frequent site of metastasis is lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). We present a case of 67 year old male, who presented with progressively increasing swelling in the left occipital region for 2 months. MRI brain showed large lobulated moderately enhancing T2 isointense to hyperintense and T1 hypointense mass lesion in occipital region, causing destruction of occipital bone with large intracranial extradural soft tissue component. Possibilities suggested were Meningioma or metastatic lesion. The scalp mass was excised. The histopathological examination of the excised tissue followed by elaborate immunohistochemistry suggested metastatic hepatocellular carcinoma, which was later confirmed by S.AFP and multiphase CT thorax, abdomen, pelvis which showed multiple liver lesions. Initial presentation of HCC as a subcutaneous lesion is very rare and only very few cases of HCC presenting with primary soft tissue swelling have been reported.