title: Extrahepatic metastases as initial manifestations of hepatocellular carcinoma: an Egyptian experience.
abstract: BACKGROUND
  The incidence of hepatocellular carcinoma (HCC) in Egypt has markedly increased in the recent years, mainly due to the high incidence of hepatitis C virus (HCV) infection. Consequently, the frequency of metastatic HCC has also increased. The current study presents a series of 47 patients who were initially diagnosed as metastatic HCC.
  
  
  METHODS
  Forty seven patients with the diagnosis of extrahepatic metastases of HCC at initial presentation were included in the study. The sites of metastases were bones (17), lymph nodes (9), soft tissue (7), omentum (7), maxillary sinus (2), adrenal gland (2), brain (2) and skin (1). The diagnosis of metastatic HCC was confirmed by immunohistochemistry.
  
  
  RESULTS
  The patients included in the study were 38 males and 9 females, ranging from 40 to 80 years (median 60 years). All patients were HCV-positive and 36 were cirrhotic. The diagnosis of primary HCC was confirmed in all cases, based on the typical hypervascular radiological features and/or high serum α-fetoprotein concentration, or histologic examination of liver biopsy.
  
  
  CONCLUSIONS
  Metastasis of HCC should be put into consideration when evaluating metastatic carcinoma with unknown primary. This is of particular importance in the Egyptian population who has the highest prevalence of HCV infection in the world.
authors.affiliation: Departments of Pathology, Faculty of Medicine, Ain Shams University, Ramses Street- New Faculty Bldg. -5th floor, P.O. # 11566, Cairo, Egypt. Thanaahelal2@hotmail.com.
authors.forename: Thanaa El A
authors.initials: Tel A
authors.lastname: Helal
authors.affiliation: Departments of Pathology, Faculty of Medicine, Ain Shams University, Ramses Street- New Faculty Bldg. -5th floor, P.O. # 11566, Cairo, Egypt. neharadwan@yahoo.com.
authors.forename: Nehal A
authors.initials: NA
authors.lastname: Radwan
authors.affiliation: Departments of Radiology, Faculty of Medicine, Ain Shams University, Ramses Street- Radiology department, Ain Shams University Hospital, P.O. # 11566, Cairo, Egypt. Mohamedshakerghazy@yahoo.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000737:chemistry / Q000473:pathology* / Q000821:virology; D004534:Egypt; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000097:blood / Q000737:chemistry / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins