Hepatocellular carcinoma metastases to the epidural space.
Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain-especially with symptoms of paresthesia, radiculopathy, or cord compression-in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.
Somerset
Hilary
H
Department of Pathology, University of Colorado Health Sciences Center, Aurora, CO 80045, USA.
Witt
J Peter
JP
Kleinschmidt-Demasters
Bette K
BK
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D004824:Epidural Space / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D014057:Tomography, X-Ray Computed