title: Metastatic hepatocellular carcinoma to the pelvis and vertebrae in a patient with chronic hepatitis 'C' with unknown primary.
abstract: A 54-year-old man infected with hepatitis C virus presented to us with pain in the right iliac fossa radiating to the back and right thigh for the past 2 months. Imaging of the abdomen and pelvis was performed, which revealed a soft tissue mass adherent to right iliac blade and right ala of sacrum. Trucut biopsy of the mass was performed and immunohistochemical stains Glypican-3 and Hep-par 1 were used for histopathological analysis, which diagnosed the mass as hepatocellular carcinoma. This is a unique case of metastasis of hepatocellular carcinoma to the bone in which imaging of the liver did not show any primary lesion. Liver function tests showed that aspartate transaminase and alanine transaminase were twice the normal range with a high viral load and significantly raised serum α-fetoprotein. The patient was treated with intravenous 5-flourouracil and radiotherapy as a palliative measure with only moderate clinical improvement.
authors.affiliation: Department of Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan.
authors.forename: Syed Hussain
authors.initials: SH
authors.lastname: Abbas
authors.affiliation: Department of Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan.
authors.forename: Muhammad Zia Ul Islam
authors.initials: MZ
authors.lastname: Khan
authors.affiliation: Department of Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ijaz
authors.affiliation: IRNUM, Peshawar, Khyber Pakhtunkhwa, Pakistan.
authors.forename: Syed Jawad Akhtar
authors.initials: SJ
authors.lastname: Hussain
mesh_terms: D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007085:Ilium / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology* / Q000628:therapy; D010388:Pelvis / Q000473:pathology; D011379:Prognosis; D012447:Sacrum / Q000473:pathology; D013131:Spine / Q000473:pathology; D016896:Treatment Outcome