title: Hepatocellular carcinoma presenting with multiple bone and soft tissue metastases and atypical cytomorphological features--a rare case report.
abstract: Hepatocellular carcinoma (HCC) with atypical cytomorphological features and presenting with bone and soft tissue metastasis is very rare. We report a 65-year-old male patient of HCC who presented with bone and soft tissue metastases and was clinically and radiologically suspected to have a soft tissue sarcoma. The patient presented with severe cervical pain with palpable masses in right scapular, nape of neck, and occiput area of scalp. Radiologically, these were large, bulky soft tissue masses expansile, destructive, and lytic in nature. Cytomorphologic studies revealed HCC with uncommon features of multinucleated osteoclast-like giant cell and very prominent intracytoplasmic hyaline bodies (IHBs). Cytology, immunohistochemistry on cell block preparation, rising serum α-fetoprotein (AFP) levels (1121.93-5000 ng/ml), and PIVKA II levels confirmed the diagnosis. The patient has been on follow-up on sorafinib for 2 months and is doing well. This case emphasizes the need for systematic approach in cases of HCC with atypical clinical presentation and unusual cytomorphology.
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India. drarchanarastogi@gmail.com
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.forename: Chhagan
authors.initials: C
authors.lastname: Bihari
authors.forename: Deepak
authors.initials: D
authors.lastname: Jain
authors.forename: Navin Lajpatrai
authors.initials: NL
authors.lastname: Gupta
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011860:Radiography, Abdominal; D035583:Rare Diseases; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D000077157:Sorafenib; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib