title: A case of isolated metastatic hepatocellular carcinoma arising from the pelvic bone.
abstract: Reports of metastatic hepatocellular carcinoma (HCC) without a primary liver tumor are rare. Here we present a case of isolated HCC that had metastasized to the pelvic bone without a primary focus. A 73-year-old man presented with severe back and right-leg pain. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed a huge mass on the pelvic bone (13×10 cm). He underwent an incisional biopsy, and the results of the subsequent histological examination were consistent with metastatic hepatocellular carcinoma. The tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1, and glypican-3, and negative for CD56, chromogranin A, and synaptophysin on immunohistochemical staining. Examination of the liver by CT, MRI, positron-emission tomography scan, and angiography produced no evidence of a primary tumor. Radiotherapy and transarterial chemoembolization were performed on the pelvic bone, followed by systemic chemotherapy. These combination treatments resulted in tumor regression with necrotic changes. However, multiple lung metastases developed 1 year after the treatment, and the patient was treated with additional systemic chemotherapy.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Sik
authors.initials: KS
authors.lastname: Jung
authors.forename: Kyeong Hye
authors.initials: KH
authors.lastname: Park
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Chon
authors.forename: Sa Ra
authors.initials: SR
authors.lastname: Lee
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Lee
authors.forename: Jin Sil
authors.initials: JS
authors.lastname: Seong
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D053673:Glypicans / Q000378:metabolism; D006801:Humans; D053556:Keratin-1 / Q000378:metabolism; D053558:Keratin-3 / Q000378:metabolism; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D010232:Paraffin / Q000378:metabolism; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D053673:Glypicans; D053556:Keratin-1; D053558:Keratin-3; D010232:Paraffin