S2671 Chest Wall Metastasis as the First Clinical Manifestation of Hepatocellular Carcinoma: A Rare Case Report

• DOI: 10.14309/01.ajg.0000712732.41313.2c
• Publication Date: 2020-10-24T06:23:42Z
• Authors: Zaid Ansari; Shehroz Aslam; Dawood Findakly; Anup Solsi; Jue Wang
• Keywords: 0301 basic medicine; 03 medical and health sciences

INTRODUCTION: Hepatocellular carcinoma (HCC) is a highly malignant tumor that mostly diagnosed at an advanced stage. Here, we report metastatic HCC in elderly man with hepatitis C virus (HCV) and alcoholic cirrhosis. Literature sparse on chest wall metastasis. CASE DESCRIPTION/METHODS: A 69-year-old Caucasian presented because of growing left mass, back pain, weight loss for three months. He had never visited physician before; history was pertinent tobacco smoking alcohol dependence. hemodynamically stable, cachectic examination >10 cm large upper non-erythematous firm, fixed palpable mass. Labs were elevated liver enzymes, ALT 141, AST 374, ALP 675, normal total bilirubin, HCV antibody positive, viral PCR 6.1 log IU/ml. CT chest, abdomen, pelvis showed extrapleural mass measuring 10.8 × 15.5 11.0 erosions adjacent ribs, destructive lytic bony lesions, cirrhosis; features suspicions HCC. Subsequent biopsy confirmed moderately differentiated Immunostain positive CAM 5.2, Hep Par, glutamine synthetase, glypican-3. serum AFP 2376.15 ng/ml. Abdominal MRI demonstrated five enhancing masses the largest 4.1 3.5 arterial enhancement, washout, diffusion restriction, internal hemorrhage consistent biopsy-proven (LR-5). brain spine unremarkable except previously reported metastases. Consequently, he received localized radiotherapy, upon completion, discharged home, currently, systemic chemotherapy Lenvatinib. DISCUSSION: second most lethal neoplasm 18% five-year survival. Common etiologies are HBV, HCV, cirrhosis, NAFLD. The frequent locations include bones, lymphatics, adrenals. Spread occurs heterogeneously or via lymphatic route by direct invasion. Extrahepatic metastasis rare even rarer, poorer prognosis when first presentation site. This should be differential rapidly masses, particularly and/or treatment-naïve virus-infected patients. Timely recognition risk factors can prevent aid early diagnosis such aggressive tumors.Figure 1.: Chest Wall Metastasis.Figure 2.: Abdomen showing Primary Liver Lesion.Figure 3.: Pathology Slide: H & E stain suggestive biopsy.