Diagnosis Of Metastatic Hepatocellular Carcinoma Research Articles

Rare Presentation of Metastatic Hepatocellular Carcinoma to The Finger, Case report and Review of the literature

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that develops in the setting of chronic liver disease. HCC is difficult to diagnosis due to it requiring the use of multiple imaging modalities with the goal to detect tumors when they are less than or equal to 2 cm in size to allow all possible treatment options to be used. Herein, we discuss a 69-year-old male with stage IV liver cancer residing in hospice presenting with left middle finger osteomyelitis and extreme pain. Radiology revealed a destructive lesion, but pathology provided the diagnosis of metastatic hepatocellular carcinoma in his finger. Even though HCC can be diagnosed on imaging alone, this case highlights the need for biopsy to provide an accurate diagnosis

The Role of Cytology in the Diagnosis of Metastatic Hepatocellular Carcinoma

The diagnosis of primary hepatocellular carcinoma (HCC) in high risk patients, such as those with chronic hepatitis B or C with/without cirrhosis of the liver, can be made with relevant image studies alone; however, morphologic confirmation by cytology or histopathology is essential to the diagnosis of metastatic HCC because the treatment of the latter differs from that of primary extrahepatic malignancy. Although both cytology and histopathology are important tools in the diagnosis of malignancy, histopathology almost always plays a confirmatory and pivotal role, and also a gold standard in cyto-histological correlation. We present two patients of metastatic HCC to rare sites; endobronchus in one, and neck lymph nodes, face and the abdominal wall in the other. Repeated bronchial biopsy in the first patient and excisional biopsy from the metastatic sites of the second patient failed to make a conclusive diagnosis of metastatic HCC. However, bronchial brushing in the first patient and fine needle aspiration cytology from the respective metastatic sites of the second patient consistently showed characteristic HCC features and provided clinicians with the rationale for ongoing treatment. The diagnostic issues and possible pitfalls are discussed. Cytology and histopathology appear equipollent; sometimes cytology can play a diagnostic role when histopathology fails its expected role in this scenario.

Transesophageal Bronchoscopic Ultrasound-Guided Fine-Needle Aspiration for Metastatic Vertebral Body Lesion.

Malignant neoplasms frequently cause vertebral metastases. Traditionally, either image-guided percutaneous biopsy or open biopsy has been performed for sampling specimens for the definitive diagnosis. We herein report a case with suspected multiple metastases but unknown primary, who underwent endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph nodes with negative results by rapid onsite cytologic evaluation, followed by the transesophageal approach with the ultrasound bronchoscope for the vertebral body lesion at the same setting that provided a definitive diagnosis of metastatic hepatocellular carcinoma.

Delayed presentation and diagnosis of metastatic hepatocellular carcinoma in pregnancy.

Hepatocellular carcinoma (HCC) is rare in women of reproductive age. If diagnosed, the underlying cirrhosis is associated with infertility in the majority of cases. There is limited literature on HCC in pregnancy, even more so for cases of metastatic disease. We present a case of delayed presentation and diagnosis of metastatic HCC in pregnancy. A 30-year-old pregnant woman presented at 23 weeks’ gestation and was diagnosed as HIV-infected, with anaemia. She was initiated on an efavirenz-based fixed-dose combination and oral haematinics. She subsequently presented at 32 weeks’ gestation with dyspnoea, and was diagnosed with pre-eclampsia. She was also found to have hepatosplenomegaly and ascites. She went into spontaneous preterm labour at 32 weeks and 4 days. A diagnosis of metastatic HCC was made postpartum, based on the radiological findings and biochemistry. We discuss the challenges of diagnosing metastatic HCC in pregnancy.

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

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.

Hepatocellular carcinoma metastasis to the gingival soft tissues: A case report and review of the literature

Metastases to the gingival soft tissues are rare in hepatocellular carcinoma (HCC). To the best of our knowledge, only 13 cases have been reported in English literature to date. The present study described the case of a 43-year-old Chinese man who was admitted to Tangdu Hospital (Xi'an, China) due to the presence of a gingival tumor that was initially diagnosed as granulation tissue by a dental surgeon. Examination of the patient's medical history revealed that a solid mass, measuring 1.5 cm in diameter, was identified in the right lobe of the liver 2 years prior to presentation at the current hospital; however, no biopsy was performed. Thus, the tumor was resected and histological examination resulted in an initial diagnosis of atypical squamous cell carcinoma. However, the histopathological characteristics, immunohistochemical features and serum α-fetoprotein expression levels supported a diagnosis of metastatic HCC. In conclusion, the present case study highlights the difficulties in diagnosing metastatic HCC without a history of primary HCC, and the importance of excluding a diagnosis of metastatic tumor when a lesion is identified in the gingival. Furthermore, it was determined that a final diagnosis of gingival metastasis of HCC predominantly depends on pathological characteristics and immunohistochemical features.

Subdural hemorrhage from a hepatoma due to metastasis

Dural metastasis with subdural hemorrhage is very rare. We report a 69-year-old woman who visited our emergency department with a history of nausea and vomiting for 6 days. Computed tomography of the brain with enhancement showed a space-occupying lesion over temporal skull with subdural hematoma. Abdominal sonography revealed a liver tumor. Emergent craniotomy and resection of intracranial tumor were performed because of impaired consciousness on the 4 th day after admission. A pathological analysis of the cranial lesion later confirmed the diagnosis of metastatic hepatocellular carcinoma with skull involvement. After a complete survey of her hepatoma, she received tumor embolization and was discharged. However, 6 months later, she died because of multiple brain metastases, leading to subdural hemorrhage and intracranial hemorrhage. Although intracranial metastatic lesions are rare, they are life-threatening because of the lack of obvious history that usually leads to delayed diagnosis. A literature review was performed to shed light on the frequency and importance of this rare but important clinical entity.

Metastatic hepatocellular carcinoma: When surgery and successive palliative treatments lead to remission

Hepatocellular carcinoma (HCC) is the third leading cause of death by cancer worldwide. The prognosis of patients with metastatic HCC remains limited, with an expected median survival lower than 50% at 1 year. Here, we report the case of a 63-year-old man who suffered from a small HCC in the liver and a large unique metastasis in the right adrenal gland. A surgical resection of both lesions was performed. Seven months later, HCC recurred with an isolated right renal metastatic lymphadenopathy and a high alpha-fetoprotein level. HCC was brought under control by sorafenib; the alpha-fetoprotein level was greatly reduced but remained moderately elevated and stable over 2 years after the onset of chemotherapy. Additional external radiotherapy on the metastatic lymphadenopathy led to a normalization of the alpha-fetoprotein level and discontinuation of sorafenib treatment. One year after the end of radiotherapy, a second isolated metastasis occurred in the right lung. This tumor was surgically removed. Twenty-one months after this second surgical procedure, i.e., more than 5.5 years after the initial diagnosis of metastatic HCC, the patient was asymptomatic and tumor free.

Intracellular and extracellular hyaline globules in endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph node: A clue for the diagnosis of metastatic hepatocellular carcinoma

Intracellular and extracellular hyaline globules in endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph node: A clue for the diagnosis of metastatic hepatocellular carcinoma

Occult hepatocellular carcinoma metastasising to the left temple diagnosed by fine-needle aspiration biopsy

Although hepatocellular carcinoma (HCC) is relatively rare in Western countries, it is one of the most prevalent cancers worldwide. Metastatic spread outside the liver is common and typically occurs in the setting of advanced disease. Metastatic disease is the initial presentation of HCC in less than 5% of cases and even fewer are diagnosed by cytology. We present the cytological findings in an 85-yr-old man of a soft tissue mass in the left temple, which suggested the diagnosis of an occult HCC. Fine-needle aspiration biopsy showed moderately cellular smears with large malignant epithelial cells present in fragments, with apposition of endothelial cells to the tumour cells. Deposits of non-refractile green pigment consistent with bile were present. Investigations revealed abnormal liver function tests, and a large mass replacing much of the liver. In view of the cytology and clinico-radiological correlation, a diagnosis of metastatic HCC was made.

Chest wall metastasis from unknown primary site of hepatocellular carcinoma

Previous reports of a solitary metastatic hepatocellular carcinoma have been rare. Because this tumor has a different treatment modality and prognosis, an accurate differential diagnosis is essential. Here we report a rare case of a solitary chest wall metastasis from unknown primary site of hepatocellular carcinoma. It involves a 51-year-old man who was admitted to our hospital because of a palpable left upper chest wall mass. The mass was resected and pathologic examination confirmed a diagnosis of metastatic hepatocellular carcinoma. Despite our investigation, no evidence was found that indicated the primary origin of the hepatocellular carcinoma. Four months later, the patient was admitted again because of spinal cord compression at the third and fourth thoracic vertebrae. Emergent decompressive laminectomy was performed and microscopic features revealed the same pathology as the initial chest wall mass resected 4 months earlier. After one year, a follow-up abdominal computed tomography (CT) still revealed no evidence of primary hepatocellular carcinoma.

Metastatic hepatocellular carcinoma of the breast, simulating gynecomastia: Diagnosis by fine‐needle aspiration biopsy

Hepatocellular carcinoma (HCC) may uncommonly present with distant metastasis in the absence of a documented neoplasm in the liver. The authors herein describe the case of a 60-year-old man with cirrhosis who developed unilateral enlargement of the breast and a subareolar mass. This problem was clinically thought to represent gynecomastia, but a mammary fine-needle aspiration biopsy demonstrated a malignant epithelial neoplasm composed of large granular amphophilic cells. Bile pigment was visualized in the tumor on aspirate smears and cell block preparations; immunostains showed reactivity for cytokeratin and alpha-fetoprotein, but there was no positivity for epithelial membrane antigen, gross cystic disease fluid protein-15, vimentin, estrogen receptors, progesterone receptors, or S100 protein. These results indicated a diagnosis of metastatic HCC, which was subsequently confirmed by computed tomography of the abdomen.

Cardiac Metastasis of Hepatocellular Carcinoma Mimicking Pericardial Effusion on Radionuclide Angiocardiography

A 51-year-old man presented with exertional dyspnea for two months. He had a history of hepatocellular carcinoma that was totally resected three years earlier. Radionuclide angiocardiography disclosed a large photopenic area separating the heart from the liver, and lung blood pools mimicking a large pericardial effusion. Echocardiography and magnetic resonance imaging of the heart, however, showed extensive tumor infiltration of the myocardium of both ventricles. Endomyocardial biopsy confirmed the diagnosis of metastatic hepatocellular carcinoma. There was no evidence of recurrent hepatoma in the liver.