title: A case of well-differentiated minute hepatocellular carcinoma with extrahepatic metastasis.
abstract: A rare case of well-differentiated minute hepatocellular carcinoma (HCC) metastasizing to distant sites in a 77-year-old man with hepatitis C virus (HCV)-related cirrhosis is presented. Ultrasonography (US) disclosed a 9 mm hypoechoic lesion in segment seven (S7) of the liver, although computed tomography (CT), magnetic resonance imaging (MRI) and angiography did not reveal any space-occupying lesion. Ultrasound-guided biopsy showed the histological features of well-differentiated HCC. A plain film of the abdomen and CT revealed osteolytic changes in the sacrum and the lumbar vertebra. Ultrasound-guided biopsy of the sacrum revealed well-to-moderately differentiated HCC metastasizing from the liver. Percutaneous ethanol injection therapy (PEIT) effected complete response and completely eliminated the abnormal findings on US. Three months after PEIT, metastasis to the thoracic vertebra was revealed by CT, despite negative alpha-fetoprotein-mRNA in serum. This is the first report describing a well-differentiated HCC with metastatic potential. Further studies may provide insights into metastasis of well-differentiated HCC.
authors.affiliation: Department of Gastroenterology, Kobe Asahi Hospital, Japan. asahi@usr.omninet.co.jp
authors.forename: S R
authors.initials: SR
authors.lastname: Kim
authors.forename: Y
authors.initials: Y
authors.lastname: Hayashi
authors.forename: T
authors.initials: T
authors.lastname: Matsuoka
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Shintani
authors.forename: K
authors.initials: K
authors.lastname: Sasaki
authors.forename: J
authors.initials: J
authors.lastname: Asano
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: K I
authors.initials: KI
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Imoto
authors.forename: H
authors.initials: H
authors.lastname: Itoh
authors.forename: M
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology*; D008297:Male; D012333:RNA, Messenger / Q000097:blood; D000509:alpha-Fetoproteins / Q000235:genetics
chemical_list: D012333:RNA, Messenger; D000509:alpha-Fetoproteins