Synchronous Hepatocellular Carcinoma Research Articles

Multi-detector computed tomography evaluation of synchronous hepatocellular carcinoma and other solid malignancies.

To review the findings of multi-detector computed tomography (MDCT) in synchronous hepatocellular carcinoma (HCC) and other solid malignancies. A total of 74 cases were included in this retrospective analysis, all of them confirmed with a diagnosis of synchronous HCC and other solid malignancies. They were 41 women and 33 men (mean age, 63.36 years). The whole body and triphasic abdominal CT scanning utilized 128 MDCT scanners in all 74 patients. The pathological diagnoses of all 148 malignancies were confirmed in all 74 cases. Out of 3480 patients with HCC, 74 patients (2.1%) were diagnosed with another synchronous primary solid malignancy. The pathology of all 148 cancers was verified, and each one was correctly characterized, assessed, and staged. Hepatocellular carcinoma was detected in all 74 patients. The most frequent extra-hepatic primary malignant sites were breast (18/74, 24.3%), followed by kidney (15/74, 20.3%), lymphoma (9/74, 12.2%), uterus (7/74, 9.5%), ovary (5/74, 6.8%), colon (5/74, 6.8%), prostate (5/74, 6.8%), urinary bladder (3/74, 4.1%), thyroid (2/74, 2.7%), gall bladder (1/74, 1.4%), stomach (1/74, 1.4%), pancreas (1/74, 1.4%), esophagus (1/74, 1.4%) and lung (1/74, 1.4%). The possibility of synchronous double malignancies with HCC should always be considered during pretreatment evaluation. Using an MDCT scanner, researchers were able to assess this occurrence accurately. An increased number of such findings may lead to an improved therapeutic method for these patients.

Clinical outcomes of patients with two small hepatocellular carcinomas.

BACKGROUNDManagement of single small hepatocellular carcinoma (HCC) is straightforward with curative outcomes achieved by locoregional therapy or resection. Liver transplantation is often considered for multiple small or single large HCC. Management of two small HCC whether presenting synchronously or sequentially is less clear.AIMTo define the outcomes of patients presenting with two small HCC.METHODSRetrospective review of HCC databases from multiple institutions of patients with either two synchronous or sequential HCC ≤ 3 cm between January 2000 and March 2018. Primary outcomes were overall survival (OS) and transplant-free survival (TFS).RESULTS104 patients were identified (male n = 89). Median age was 63 years (interquartile range 58-67.75) and the most common aetiology of liver disease was hepatitis C (40.4%). 59 (56.7%) had synchronous HCC and 45 (43.3%) had sequential. 36 patients died (34.6%) and 25 were transplanted (24.0%). 1, 3 and 5-year OS was 93.0%, 66.1% and 62.3% and 5-year post-transplant survival was 95.8%. 1, 3 and 5-year TFS was 82.1%, 45.85% and 37.8%. When synchronous and sequential groups were compared, OS (1,3 and 5 year synchronous 91.3%, 63.8%, 61.1%, sequential 95.3%, 69.5%, 64.6%, P = 0.41) was similar but TFS was higher in the sequential group (1,3 and 5 year synchronous 68.5%, 37.3% and 29.7%, sequential 93.2%, 56.6%, 48.5%, P = 0.02) though this difference did not remain during multivariate analysis.CONCLUSIONTFS in patients presenting with two HCC ≤ 3 cm is poor regardless of the timing of the second tumor. All patients presenting with two small HCC should be considered for transplantation.

Synchronous hepatocellular carcinoma and gallbladder adenocarcinoma with neuroendocrine differentiation: a case report and literature review

BackgroundDouble primary cancers have a low incidence rate, and synchronous hepatocellular carcinoma and gallbladder adenocarcinoma are rarely reported. Here, we report such a case— the 12th case of synchronous double primary cancers featuring HCC and GC, but the first case of neuroendocrine differentiation in the gallbladder.Case presentationA 77-year-old female was admitted to the hospital complaining of weakness and inappetence for six months. Contrast-enhanced computed tomography (CT) of the abdomen indicated an 11 cm space-occupying lesion in the right lobe of the liver. Later, magnetic resonance imaging showed a high possibility of a massive hepatoma, and multiple gallstones were also seen. After transhepatic arterial chemoembolization, a repeat abdominal CT showed obvious local nodular thickening in the gallbladder wall. Finally, resection of the right lobe of the liver and cholecystectomy were performed. During an approximately 2-year follow-up, the patient recovered uneventfully without recurrence or metastasis.ConclusionThe disease in this case is rare and lacked typical radiological features. More precise and advanced diagnostic techniques are needed to obtain a clear diagnosis and refine treatment strategies. The management strategy should always be curative, even in the presence of multiple malignancies.

Somatic mutations and clonal dynamics in healthy and cirrhotic human liver.

SummaryThe commonest causes of chronic liver disease are excess alcohol intake, viral hepatitis or non-alcoholic fatty liver disease, with the clinical spectrum ranging in severity from hepatic inflammation through cirrhosis to liver failure or hepatocellular carcinoma. The hepatocellular carcinoma genome exhibits diverse mutational signatures, resulting in recurrent mutations across >20-30 cancer genes1–7. Stem cells from normal livers have low mutation burden and limited diversity of signatures8, suggesting that the complexity of hepatocellular carcinoma arises during progression to chronic liver disease and subsequent malignant transformation. We sequenced whole genomes of 482 microdissections of 100-500 hepatocytes from 5 normal and 9 cirrhotic livers. Compared to normal liver, cirrhotic liver had higher mutation burden. Although rare in normal hepatocytes, structural variants, including chromothripsis, were prominent in cirrhosis. Driver mutations, both point mutations and structural variants, affected 1-5% clones. Clonal expansions millimetres in diameter occurred in cirrhosis, sequestered by bands of fibrosis engirdling regenerative nodules. Some mutational signatures were universal and equally active in both non-malignant hepatocytes and HCC; some were substantially more active in HCC than chronic liver disease; and others, arising from exogenous exposures, were present in a subset of patients. Up to 10-fold within-patient variation in activity of exogenous signatures existed between adjacent cirrhotic nodules, arising from clone-specific and microenvironmental forces. Synchronous hepatocellular carcinomas exhibited the same mutational signatures as background cirrhotic liver, but with higher burden. Somatic mutations chronicle the exposures, toxicity, regeneration and clonal structure of liver tissue as it progresses from health to disease.

A Patient with Synchronous Primary Hepatocellular Carcinoma and Primary Pancreatic Ductal Adenocarcinoma

The incidence of synchronous double primary malignancies is rare. There were only two cases with synchronous hepatocellular carcinoma (HCC) and pancreatic cancer has been reported so far (J Surg Case Rep 2017(9):rjx182, 2017; Indian J Palliat Care 20:53–6, 2014). Whether double primary malignancies to be operable is an interesting and important issue for surgeon. Here, we report a rare case of synchronous double primary malignancies of the liver and pancreas received simultaneous hepatic segmentectomy and pancreaticoduodenectomy.

A case of resected synchronous hepatocellular and cholangiolocellular carcinoma in the background of resolved hepatitis B virus infection

An 85-year-old male patient was referred to our hospital for further examination of a liver tumor. Imaging examination revealed a 90-mm tumor in segment 4/8 and 30-mm tumor in segment 6 of the liver. Histopathological examination revealed that the tumor in segment 4/8 was cholangiolocellular carcinoma (CLC) and the tumor in segment 6 was hepatocellular carcinoma (HCC). This case shows that although the frequency of CLC is very low, recent studies have indicated the novel knowledge of CLC. Herein, we report a surgical case of CLC and HCC in the background of resolved hepatitis B virus infection.

Aggressive intrahepatic therapies for synchronous hepatocellular carcinoma with pulmonary metastasis.

Prognosis of synchronous hepatocellular carcinoma (HCC) patients with pulmonary metastasis (PM) was poor, while aggressive intrahepatic therapies remained controversial. This study aimed to investigate the significance of aggressive intrahepatic therapies for synchronous PM-HCC. Synchronous PM-HCC patients were retrospectively enrolled from Sun Yat-sen Memorial Hospital of Sun Yat-sen University during January 2000 and December 2015. Univariate and multivariate analysis were performed to investigate the prognostic factors. Patients were grouped according to different HCC treatment modalities including liver resection (LR), ablation, transarterial chemoembolization (TACE), systemic therapy (ST, systemic chemotherapy or sorafenib) and supportive care (SC). Case control studies were achieved using propensity score matching (PSM) analysis to further investigate the significance of LR, ablation and TACE. Eighty-one patients were enrolled, and the median overall survival (OS) was 4.5months. Serum alpha fetal protein (AFP)≥400ng/ml, multiple HCC lesions and no intrahepatic therapies (LR/Ablation/TACE) were inferior independent prognostic factors. Patients were divided into LR group (n=9), Ablation/TACE group (n=24) and ST/SC group (n=48). After PSM analysis, survival outcome was superior in LR group compared to Ablation/TACE group (19.6 vs. 6.9months) (p=0.023) or ST/SC group (19.6 vs. 2.8months) (p=0.034), while no significant difference was found between -Ablation/TACE and ST/SC group (5.1 vs. 3.2months) (p=0.338). Prognosis of synchronous PM-HCC patients was poor. Serum AFP≥400ng/ml, multiple HCC lesions and no aggressive intrahepatic therapies were inferior prognostic factors. LR might provide survival benefits in well-selected patients, while the significance of ablation or TACE remained to be further investigated.

Variation of stemness markers expression in tumor nodules from synchronous multi-focal hepatocellular carcinoma \u2013 an immunohistochemical study

BackgroundAdvancing knowledge in molecular pathogenesis of hepatocellular carcinoma (HCC) opens up new horizons in the diagnostic, prognostic and therapeutic perspectives. Assessing the expression of molecular targets prior to definitive treatment is gaining importance in clinical practice. In this study, we investigated the variation in expression pattern of stemness markers in synchronous multi-focal HCC.MethodsIn the first cohort, 21 liver explants with multi-focal HCC were examined for expression of stemness markers EpCAM, Sox9 and CK19 by immunohistochemistry (IHC). Expression data of 50 tumor nodules were analyzed to determine the concordance of expression among nodules in the same livers. In the second cohort, 14 tumor nodules from 6 multi-focal HCC cases proven as intra-hepatic metastasis were examined for Soc9 immunoexpression.ResultsIn the first cohort, thirty nodules from 16 cases expressed one or more markers, with Sox9 being most frequently expressed. Complete concordance of expression pattern for all 3 markers was observed in 6 cases. Discrepancy of staining degree was noted in 4 cases for EpCAM, 14 cases for Sox9, and 6 cases for CK19. A two-tier or three-tier difference in staining scores was noted in 5 cases for Sox9 and one case for CK19. With Sox9, identical tumor morphology in terms of Edmondson grading and growth pattern did not infer the same degree of immunoexpression; and the largest tumor nodule was not representative of highest IHC score. In the second cohort of intra-hepatic metastasis, complete concordance of Sox9 expression level was observed in 5 out of 6 cases; while the remaining case showed a 1-tier difference of positive staining.ConclusionsOur findings suggested that clonality of tumor nodules is apparently an important factor to infer immunoexpression pattern. When there is limited information to discern multiple primaries versus intra-hepatic metastasis in multi-focal HCC, discordant degree of stemness markers expression among tumor nodules was commonly observed especially for markers with higher frequency of expression. Pathological features alone do not necessarily indicate the expression pattern of the synchronous nodule and in this scenario examination of each tumor nodule is justified.

Co-occurrence of liver metastasis of gastrointestinal stromal tumor and hepatocellular carcinoma: a case report.

Gastrointestinal stromal tumors (GISTs) are potentially malignant mesenchymal tumors that can give rise to distant metastases, mainly in the liver. The co-occurrence of synchronous primary liver tumors (e.g., hepatocellular carcinoma (HCC)) in patients with GIST is extremely rare. This report describes a 77-year-old male patient with liver metastasis of GIST originating in the small intestine and synchronous HCC. The patient had undergone resection of the small intestine for the primary GIST 3 years earlier and partial hepatectomy and radiofrequency ablation for liver metastases of GIST 1 year earlier. Despite the continuation of adjuvant therapy with imatinib, two new lesions in the liver were detected by follow-up computed tomography scanning, which showed the gradual enlargement of one tumor. A second hepatectomy was performed. Pathological examination revealed that one tumor was a liver metastasis of GIST and the other was a primary HCC. To our knowledge, this is the first report of the synchronous co-occurrence of a liver metastasis of GIST and a primary HCC.

Metastatic colorectal cancer in a cirrhotic liver with synchronous hepatocellular carcinoma.

We are reporting a case of a patient with a previous history of colorectal cancer (CRC) and cirrhosis, who developed concurrent liver lesions consistent with hepatocellular carcinoma (HCC); a case which is unique due to the low incidence of multiple cancers, particularly HCC in the setting of previous advanced colorectal carcinoma along, in a cirrhotic liver. We will review the known literature on multiple cancer rates found in patients with known colorectal carcinoma. We will then outline this particular patient's presentation, followed by a discussion as to why the particular concurrent development of HCC in the setting of previous CRC is of note.

Abstract 4814: Inferring liver cancer evolution from spatial and temporal genomic heterogeneity

Abstract Background & Aims: The molecular pathogenesis of primary liver cancer is extremely complex and heterogeneous, which was further complicated by multiple carcinogenesis. We aimed to elucidate the pathogenesis of multifocal primary liver cancer by genomic profiling. Methods: A patient with synchronous hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) who underwent resection and experienced post-operative intrahepatic metastases (IMs) was enrolled. Multiregion whole-exome sequencing was applied on the three primary tumors and two IMs to infer tumor clonality and evolution. The mutational and expression profiles, clinical relevance (n = 236) and functional implications of the identified potential driver gene FAT4 in HCC were investigated. Results: In total, we identified 12, 184, 126, and 54 of protein coding mutation in the cirrhotic liver, two HCCs (designated as HCC-A and HCC-B) and one ICC respectively. The mutational data of the two HCCs and one ICC showed almost no overlaps, suggesting that they developed through an accumulation of complete different sets of genetic alterations. For each tumor, multiregion sequencing data showed varied intratumoral heterogeneity (18.1% in HCC-A, 15.7% in HCC-B, 45.6% in ICC). The mutational profile of two IMs showed obvious similarity with HCC-A (87.6% and 87.7% shared with HCC-A respectively), rather than HCC-B and ICC tumors, indicating that they originated from HCC-A. Notably, FAT4 was the only gene that mutated in both HCCs and the two IMs, but in different locations (HCC-A and two IMs have the same G to A mutation at the coding position 2530, while HCC-B genomes have the A to C mutation at the coding position 14804). Prevalence screen revealed that FAT4 was mutated in over 15% of HCC patients and also several HCC cell lines. Significant down-regulation of FAT4 mRNA and protein expression was found in HCC, and loss of FAT4 independently correlated with early recurrence in HCC patients. In HCC cell lines, knockdown of FAT4 promoted and re-expression of FAT4 reduced cell growth and invasion. Conclusions: Spatial and temporal dissection of genomic alterations during the progression of liver cancer may help elucidate the basis for its dismal prognosis. FAT4 acts as a putative tumor suppressor that is frequently inactivated in human HCC. Citation Format: Qiang Gao, Zhi-Chao Wang, Rui-Bin Xi, Jia Fan. Inferring liver cancer evolution from spatial and temporal genomic heterogeneity. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4814. doi:10.1158/1538-7445.AM2015-4814

Synchronous development of intrahepatic cholangiocarcinoma and hepatocellular carcinoma in different sites of the liver with chronic B-viral hepatitis: two case reports

BackgroundSynchronous development of primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma has been reported rarely. In literature review, there have been only 35 reported cases of synchronous hepatocellular carcinoma and intrahepatic cholangiocarcinoma, and most of these tumors developed in patients with hepatitis C-related liver cirrhosis. Here, we present synchronous development of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in two patients with chronic B-viral hepatitis.Case presentationTwo patients with chronic hepatitis B were referred to our hospital due to a hepatic mass. Patient 1 had a 6.4 cm multinodular hepatic mass in the left lobe and a small nodule in the right lobe. Patient 2 had a 4.3 cm hypervascular mass in the right lobe and a 1.1 cm nodule in the left lobe. The pre-operative diagnosis of both cases was hepatocellular carcinoma with metastatic nodule, however, surgical resection pathology revealed that hepatocellular carcinoma and intrahepatic cholangiocarcinoma existed independently in the other side of the liver in both cases. Additionally, the background liver histology of both cases was hepatitis B-related chronic hepatitis without cirrhotic change.ConclusionOur cases suggest that hepatitis B virus infection can also predispose to development of double liver cancers.

Collision tumors of hepatocellular carcinoma and malignant peritoneal mesothelioma

We report a case of synchronous hepatocellular carcinoma (HCC) and malignant peritoneal mesothelioma (MM-per). A 56-year-old man with no past history of asbestos exposure, chronic viral hepatitis, or alcoholic liver injury was admitted to our hospital with left flank pain and abdominal tumor. Partial hepatectomy, splenectomy, partial diaphragm resection, and partial gastrectomy were performed. The tumor in the lateral segment of the liver was gray to white, massive in appearance, and contained focal bile-producing nodules and extensive fibrous firm lesion. It had directly invaded the spleen and diaphragm. Liver cirrhosis was not found. The peritoneum contained multiple small nodules especially around the diaphragm, which mimicked carcinoma dissemination. After histological examination, the liver tumor was diagnosed as HCC. It had trabecular and scirrhous patterns and positive immunoreactivities for Hep-Par-1 and α-fetoprotein. The peritoneal nodules were diagnosed as MM-per, epithelioid type, with positive immunoreactivities for calretinin and cytokeratin 5/6. The two tumors collided around the diaphragm. Cases of MM synchronous with other primary malignant tumors have been reported, but most had a history of asbestos exposure unlike the present case. The carcinogenic background was unclear for two tumors in this case. This is an extremely rare and valuable case.

Synchronous Hepatocellular Carcinoma with Renal Cell Carcinoma: A Case Report and Review of Literature of Multiple Synchronous Primary Malignancies

Multiple synchronous primary malignancies have been reported since the 19th century. A number of proposed theories as to the predisposing factors have been discussed. The criteria to diagnose multiple primary malignancies have been revised by Warren and Gates. We hereby present a case of an asymptomatic individual detected with a synchronous hepatocellular carcinoma and a renal cell carcinoma, its presentation, diagnosis, and the management. The occurrence of synchronous hepatocellular carcinoma with renal cell carcinoma is very rare and only a few cases have been reported. Synchronous extrahepatic primary malignancies have been reported in a few studies across the world though with a varied incidence rate. The occurrence seems to be in the older age group without gender differentiation. The extrahepatic malignancies were more common in cirrhotic livers though the overall survival does not differ between patients with hepatocellular carcinoma alone and hepatocellular carcinoma with synchronous extrahepatic malignancies.

Synchronous hepatocellular carcinoma and Castleman's disease: The role of the interleukin-6-signaling pathway

Synchronous hepatocellular carcinoma and Castleman's disease: The role of the interleukin-6-signaling pathway

Indeterminate 1-2-cm nodules found on hepatocellular carcinoma surveillance: Biopsy for all, some, or none?

In the latest hepatocellular carcinoma (HCC) management guidelines by the American Association for the Study of Liver Diseases, biopsy is advocated for all nodules deemed indeterminate after imaging work-up by contrast-enhanced scans. However, the latest guidelines' imaging work-up algorithm has been shown to improve sensitivity of characterization of HCC for 1-2-cm nodules, decreasing the proportion of HCCs that remain indeterminate after imaging work-up. We undertook a study of 1-2-cm indeterminate nodules to determine what proportions are malignant and which variables can be used to limit biopsy to a subset of nodules at higher risk of malignancy. Eighty consecutive patients with 93 indeterminate nodules were included. Final diagnosis was established in 85 nodules, with 13 malignant (9 by biopsy, 4 by growth) and 72 benign (stability of ≥18 months). Cause of liver disease, ethnicity, size, arterial hypervascularity, venous hypoenhancement, and presence of synchronous typical HCC were analyzed by univariate logistic analysis to determine significant predictors of malignancy. Rate of malignancy among indeterminate 1-2-cm nodules was found to be 14%-23%. Only arterial hypervascularity [odds ratio (OR), 3.7) and presence of synchronous HCC (OR, 7.1) were significant predictors of malignancy. A strategy of limiting biopsy to nodules that had either feature would result in 23 biopsies and potentially detect 8 of 13 malignant nodules, yielding a sensitivity of 62% and specificity of 79%. The prevalence of malignancy among 1-2-cm indeterminate nodules is low (14%-23%), and biopsy of all such nodules results in many negative results. Limiting biopsy to nodules with arterial hypervascularity or in the presence of a synchronous typical HCC would detect the majority of HCCs while substantially reducing the number of biopsies.

Synchronous Hepatocellular Carcinoma and Gastric Carcinoma—A Case Report with Review of the Literature

Synchronous Hepatocellular Carcinoma and Gastric Carcinoma—A Case Report with Review of the Literature

A case of synchronous hepatocellular carcinoma and aortic body chemodectoma in a dog — Pathological case report

The authors describe a case of synchronously occurring (double) tumours, i.e. primary hepatocellular carcinoma and aortic body chemodectoma in a 14-year-old mixed-breed male dog. The tumours were identified during necropsy, following euthanasia. In the last months of its life, the dog showed signs of weakness, anorexia, apathy, inactivity, and abdominal palpation elicited a painful reaction. The primary liver cancer emerged in the left lateral lobe without evidence of any distant metastases. Histopathological and immunohistochemical investigations revealed a well-differentiated, trabecular, claudin-7-, claudin-5- and pancytokeratin-negative hepatocellular carcinoma. The Ki-67 proliferation index was 33%. During necropsy, a synchronously occurring benign, grade I type aortic body chemodectoma was also detected in the dog. This neuroendocrine tumour showed chromogranin-, synaptophysin-, neuron-specific enolase- and S100 protein-positivity, and the Ki-67 proliferation index was 2%. The authors believe that this is the first description of synchronously occurring hepatocellular carcinoma and aortic body chemodectoma in a dog.

Synchronous Hepatocellular Carcinoma and Renal Cell Carcinoma in a Liver Transplant Recipient: A Case Report

A 52-year-old male with liver cirrhosis secondary to hepatitis virus C, Child-Pugh score of C10, and Model for End-stage Liver Disease score of 20 was listed for liver transplant. During the pretransplant management, an abdominal computed tomography (CT) and magnetic resonance imaging (MRI, Fig. 1) showed a 2.7×2.2 cm mass in the liver and a 1.7×1.2 cm tumor in the right kidney. The liver mass on the CT was hyperdense with the liver parenchyma in the early arterial phase of contrast enhancement and hypodense in the portal phase; on the MRI, on T1-weighted sequences, it was hypointense to the liver and, on T2-weighted, it was hyperintense, suggesting hepatocellular carcinoma (HCC). The renal tumor on the CT and was a solitary solid lesion with contrast enhancement during the arterial phase; on the MRI, on T2-weighted images, it was hyperintense to the liver; on T1-weighted, it was hypointense, with a high degree of confidence in diagnosing renal cell carcinoma (RCC).FIGURE 1.: MRI of the upper abdominal cavity showing a mass in the right lobe of the liver and another one the in upper portion of the right kidney.Being a Child-Pugh C patient, he had a prohibitive risk to perform either a biopsy of the kidney tumor or its resection. Based on the fact that renal metastasis from a primary hepatocellular carcinoma is a extremely rare event (1), on the initial stage of both tumors and finally on the MRI and CT findings, we considered the possibility of two synchronous tumors and decided not to contraindicate the liver transplant. During the liver transplantation procedure, after the recipient's hepatectomy, we performed a partial nephrectomy to resect the kidney mass. Then, the donor liver was implanted. Histopathological analysis confirmed a synchronous HCC and RCC. He showed a good recovery and left the hospital 7 days after the transplant. His immunosuppression regimen was based on tacrolimus and prednisone. After a 12-month follow-up, patient is alive with good graft function and has no clinical or CT sign of any other tumor. Synchronous early primary cancers are rare. One study showed an incidence of 3.7% of synchronous cancers related to RCC. The most common sites involved were prostate, bladder, and lung. The occurrence of synchronous RCC and HCC is extremely rare (2). There is just one case of synchronous HCC and RCC resected simultaneously during a liver transplantation procedure, recently published on the literature (3). The prognosis of RCC is not likely to be changed by immunosuppression. However, a 5-year follow-up is necessary to confirm the results. The possibility of a synchronous tumor should be considered in cirrhotic patients with HCC. Jose Huygens Parente Garcia Gustavo Rego Coelho Fernanda Paula Cavalcante Jose Telmo Valença Junior Ivelise Regina Canito Brasil Gleydson Cesar-Borges Paulo Everton Garcia Costa Cyntia Ferreira Gomes Viana Tarciso Daniel Santos Rocha Joao Batista Marinho Vasconcelos Centro de Transplante de Figado do Ceara Hospital Universitario Walter Cantidio Fortaleza, Brazil

Unusual presentation of metastatic hepatocellular carcinoma in the nasal septum: a case report and review of the literature

Hepatocellular carcinoma with sinonasal metastasis is extremely rare. We report a case of a 49-year-old man who had a history of synchronous hepatocellular carcinoma and verrucous carcinoma of tongue. A painless and non-bleeding mass was found in the left nasal septum 16 months after hepatocellular carcinoma was diagnosed. On computed tomography, the mass was enhanced with contrast. It was resected and proved to be metastatic hepatocellular carcinoma. The patient was treated with radiotherapy to the nasal area and then with chemotherapy. He was still alive, 15 months after the appearance of the nasal metastasis.