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Neyrand S, Bringuier PP, Benzerdjeb N, Hervieu V, Fenouil T. [Differential diagnostic between hepatocellular carcinoma and hepatoid carcinoma with bone metastasis revelation: What tools can be used?]. Ann Pathol 2023; 43:407-411. [PMID: 36822899 DOI: 10.1016/j.annpat.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/26/2022] [Accepted: 01/04/2023] [Indexed: 02/23/2023]
Abstract
Bone metastases of hepatocellular carcinoma (HCC) are rare and disease-revealing bone metastasis are exceptional. Here, we report the case of a 69-year-old man with a cervical vertebral metastasis of hepatocellular carcinoma. Morphological aspect of a metastatic tumor with eosinophilic and polygonal cells raises the question of the differential diagnosis between a localization of a hepatocellular carcinoma or an hepatoid carcinoma, notably when the metastasis is the first clinical manifestation. The morphological aspect by itself does not provide strong enough arguments for diagnosis. Well selected immunohistochemical markers can sometimes help to orientate towards one of the two hypotheses, in particular SALL4 and LIN28 which are in favour of hepatoid carcinoma when both are positive. Finally, as these two entities have different molecular profiles, molecular study can also be helpful to distinguish them. Indeed, HCCs often present TERT promoter, CTNNB1 mutations and IL-6/JAK/STAT pathway activation while hepatoid adenocarcinoma frequently presents chromosome 20 long arm gain. TP53 mutations are found in both entities and are therefore not discriminating. Differential diagnosis is important because the treatment will be that of the primary. Prognostic data for HCC revealed by bone metastasis are scarce, although they seem to be associated with a poor prognosis, with a 1 to 2 months overall survival. There is currently no data for hepatoid adenocarcinoma with bone metastasis.
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Affiliation(s)
- Sophie Neyrand
- Institut de pathologie multisite, centre de biologie et de pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Pierre-Paul Bringuier
- Institut de pathologie multisite, centre de biologie et de pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Nazim Benzerdjeb
- Institut de pathologie multisite - Site Sud, groupement hospitalier Sud, hospices civils de Lyon, Pierre-Bénite, France
| | - Valérie Hervieu
- Institut de pathologie multisite, centre de biologie et de pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Tanguy Fenouil
- Institut de pathologie multisite, centre de biologie et de pathologie Est, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France.
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Poddar E, Shrestha S, Thapa R, Subedi S, Pathak N, Khadayat R, Regmi P. Chest wall mass as a sign of ignored hepatocellular carcinoma in an alcoholic cirrhotic patient: a case report. Ann Med Surg (Lond) 2023; 85:4092-4095. [PMID: 37554869 PMCID: PMC10406032 DOI: 10.1097/ms9.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Bone metastasis of hepatocellular carcinoma (HCC) is usually seen in the course of advanced intrahepatic HCC. Isolated bone metastasis as an initial manifestation of HCC is uncommon. CASE PRESENTATION The authors report a case of a 68-year-old male with a history of chronic alcohol consumption who presented with epigastric pain, abdominal distension, and a hard, tender lump on the right posterolateral aspect of his back. Investigation revealed HCC with isolated metastasis to the posterior thoracic wall. CLINICAL DISCUSSION HCC usually develops secondary to chronic hepatitis B and C infection in the background of chronic liver disease. Common presenting symptoms of bone metastasis include local pain, neurological manifestations, palpable subcutaneous masses, and pathological fractures. An immunohistochemistry analysis is important to differentiate HCC from non-HCC metastasis in patients without known underlying HCC. Treatment is often directed towards palliative care as the prognosis is poor. CONCLUSION An isolated rib mass can be an initial presentation of metastatic HCC. Thus, HCC with bone metastasis should be considered in the differential diagnosis in patients presenting with painful swelling in the thoracic region.
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Affiliation(s)
| | | | - Raju Thapa
- Departments of Surgical Gastroenterology
| | | | | | | | - Pradeep Regmi
- Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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John AR, Dwivedi S, Varghese J, Walia GK. Metastatic Hepatocellular Carcinoma Masquerading as an Expansile Osteolytic Lesion in Scapula: A Rare Case of Isolated Appendicular Skeletal Metastatic Involvement of Hepatocellular Carcinoma at Initial Presentation. World J Nucl Med 2023; 22:55-58. [PMID: 36923980 PMCID: PMC10010855 DOI: 10.1055/s-0042-1757288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is known to be the most common primary tumor of the liver and is also the fifth most common cancer in the world. Chronic hepatitis B and C along with type 2 diabetes mellitus and alcoholic liver disease are quite well-known risk factors for HCC, and it is uncommon in the noncirrhotic liver. HCC favors spreading as multifocal intrahepatic lesions and potential vascular invasion, and extrahepatic spread is uncommon. Skeletal metastasis from HCC occurs infrequently compared to other cancers and is common in the axial skeleton. Metastatic involvement of the appendicular skeleton is a rare entity, and the initial presentation of HCC as metastatic involvement of the appendicular skeleton is even rarer. We report a case of HCC with incidentally detected cirrhosis and chronic hepatitis B infection presenting with pain in the left shoulder.
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Affiliation(s)
- Arun Ravi John
- Department of Nuclear Medicine, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Surjeet Dwivedi
- Department of Surgical Oncology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Jeenu Varghese
- Department of Pathology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Gurpreet Kaur Walia
- Department of Pathology, Command Hospital Air Force, Bengaluru, Karnataka, India
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Kawasaki M, Shioya A, Takata M, Tsubata Y, Okanemasa Y, Takenaka M, Terauchi T, Yamashita M, Kumagai M, Yamada S. A case of bone metastasis of hepatocellular carcinoma: Mallory hyaline bodies can lead to the correct cytological diagnosis. Diagn Cytopathol 2023; 51:E70-E74. [PMID: 36345980 DOI: 10.1002/dc.25072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
Hepatocellular carcinoma (HCC) accounts for most primary tumors of the liver. Although bone metastasis does not occur in a high percentage of patients, bone metastasis is often found first, which leads to the diagnosis of HCC. In this report, we describe a case of bone metastasis from HCC in which bone lesions were detected incidentally, and in which a cytological diagnosis was difficult to make. The patient was a 78-year-old man with a history of renal dysfunction after orthopedic surgery. He underwent a thorough examination after a bone tumor was incidentally found on abdominal CT. Plasmacytoma was suspected. Fine needle aspiration cytology revealed irregular clusters of medium-to-large atypical epithelioid polygonal cells with relatively abundant eosinophilic, somewhat granular cytoplasm, and indistinct cell borders, which led to a diagnosis of malignancy. Histologically and immunohistochemically, the tumor was diagnosed as bone metastasis of HCC. Re-examination of the cytological specimen revealed characteristic Mallory hyaline bodies (MHBs). Immunohistochemistry using a cell transfer method revealed that they were positive for low molecular weight cytokeratin, Cam5.2, in a densely granular fashion. In this case, the cytological diagnosis of HCC was difficult to make due to the unclear cytoplasmic borders and absence of bile pigment. However, the identification of MHBs can potentially guide me to the correct cytological diagnosis.
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Affiliation(s)
- Makoto Kawasaki
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Akihiro Shioya
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan.,Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Mao Takata
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Yumi Tsubata
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Yoshiiku Okanemasa
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Michiho Takenaka
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Toshie Terauchi
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Manabu Yamashita
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Motona Kumagai
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan.,Department of Pathology II, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan.,Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan.,Department of Pathology II, Kanazawa Medical University, Uchinada, Japan
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Bone metastasis of hepatocellular carcinoma: facts and hopes from clinical and translational perspectives. Front Med 2022; 16:551-573. [DOI: 10.1007/s11684-022-0928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
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