Spinal cord compression: an unusual presentation of hepatocellular carcinoma.
Hepatocellular carcinoma is the 5(th) most common cancer in men and the 2(nd) common cause of death from cancer worldwide. The tumour commonly metastasizes to the lungs, regional lymph nodes and bone. Spinal cord compression secondary to metastatic disease as a first presentation is uncommon. We describe a patient who presented with paraplegia as a first presentation of hepatocellular carcinoma. 46 year old Namibian man presented with progressive leg weakness that was associated with a dull back ache and inability to pass urine and stool. He had no history of trauma nor did he have chronic cough, night sweats or fevers. He has been treated several times for alcohol dependence. On examination he was wasted, power 0/5 in both lower limbs and a sensory level at T12. He also had a non-tender hepatomegaly with Alpha-fetoprotein of 2000. The Chest X-ray and Chest CT showed nodular opacities indicating metastatic disease and the X-ray and CT of the thoracic spine showed osteolytic lesion with destruction of the pedicle of L1. Liver and spinal biopsy confirmed the hepatocellular carcinoma. The extra hepatic manifestations of HCC are diverse and Spinal cord metastasis is of pertinent clinical importance and should thus be greatly considered.
Department of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, Namibia.
Hileni Taleni
HT
Nangolo
Department of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, Namibia.
Larrea
L
Roberto
Department of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, Namibia.
Innocent Lule
IL
Segamwenge
Department Orthopedic Surgery, Intermediate Hospital Oshakati, Oshakati, Namibia.
Andreas
A
Voigt
Namibian Institute of Pathology, Khomas, Namibia.
Fredrick
F
Kidaaga
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging* / Q000209:etiology*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging* / Q000556:secondary; D014057:Tomography, X-Ray Computed
Hepatocellular carcinoma; spinal cord compression; spine metastases