Ann Surg Treat Res.  2014 Feb;86(2):100-104. 10.4174/astr.2014.86.2.100.

Systemic metastasis of hepatocellular carcinoma responsive to multidisciplinary treatment including debulking surgery

• Jung HK
• Lee DS
• Yoon SS
• Kim HJ

• KMID: 1908505
• DOI: http://doi.org/10.4174/astr.2014.86.2.100

Abstract

The lung, followed by regional lymph node and bone, is the most common site for extrahepatic metastasis of hepatocellular carcinoma (HCC). Metastatic skin lesion of HCC is rare, and it is a sign of poor prognosis, indicating the strong possibility of metastases in other regions of the body. We report the case of a 52-year-old male with multiple metastases, including skin metastasis of HCC, which were treated with multidisciplinary therapy.

Keyword

Hepatocellular carcinoma; Skin metastasis; Sorafenib

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Lung
Lymph Nodes
Male
Middle Aged
Neoplasm Metastasis*
Prognosis
Skin

Figure

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  Fig. 1 Initial computed tomography image. A huge mass was observed in segment 8 (A), and an additional mass in segment 6 (B). Perihepatic leakage of contrast (C) was also seen, compatible with rupture of hepatocellular carcinoma.

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  Fig. 2 (A) Gross findings after segmentectomy of segment 8, and wedge resection of segment 6. (B) Microscopic findings. Microscopic finding showed no viable hepatocellular carcinoma, believed to be due to initial transarterial chemoembolization (H&E: Left, ×10; Right, ×20).

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  Fig. 3 Computed tomography image shows multiple extrahepatic metastases spleen (A), left adrenal gland (B), back muscle (C), buttock muscle (D), and skin of hepatocellular carcinoma (E).

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  Fig. 4 Magnetic resonance imaging (A, focal strong enhancing mass at left precentral gyrus) and positron emission tomography image (B, focal fludeoxyglucose hot uptake nodule on left parietal lobe) of brain metastasis. Brain metastasis was treated with radiation therapy. After radiation therapy, tumor had shrunk (C)

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  Fig. 5 Skin lesion on computed tomography image (A, arrow) and excised mass on buttock (B). (C) Microscopic finding reveals skin metastasis of hepatocellular carcinoma (H&E: Left upper, ×10; Right upper, ×20; Left lower, ×20; Right lower, ×30).

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  Fig. 6 (A) After diagnosis of multiple metastases, a new skin lesion was identified on the right thumb. (B) Magnetic resonance imaging also shows a pedunculated soft tissue mass.

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  Fig. 7 (A) Gross findings of multiple extrahepatic metastases after en bloc resection. (B) Microscopic findings reveal metastases of hepatocellular carcinoma (H&E, ×30).

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  Fig. 8 Remnant metastatic masses are still observed on back muscle (A) and buttock (B). Coronal view (C) also shows these masses.

Reference

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