title: Bone marrow metastasis presenting as bicytopenia originating from hepatocellular carcinoma.
abstract: The bone is a common site for metastasis in hepatocellular carcinoma (HCC). However, bone marrow metastasis from HCC is rarely reported, and its frequency is unclear. Here we report a rare case of bone marrow metastasis that presented as bicytopenia originating from HCC without bone metastasis. A 58-year-old man was admitted for investigation of a liver mass with extensive lymph node enlargement that was detected when examining his general weakness and weight loss. Laboratory findings revealed anemia, thrombocytopenia, mild elevated liver enzymes, normal prothrombin time percentage and high levels of tumor markers (α-fetoprotein and des-γ-carboxyprothrombin). Abdominal computed tomography showed multiple enhanced masses in the liver and multiple enlarged lymph nodes in the abdomen. A bone marrow biopsy revealed only a few normal hematopoietic cells and abundant tumor cells. Despite its rarity, bone marrow metastasis should always be suspected in HCC patients even if accompanied by cirrhosis.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Woo
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Lim
authors.affiliation: Gene & Cell Therapy Research Center for Vessel-associated Diseases, Yangsan, Korea.
authors.forename: S M
authors.initials: SM
authors.lastname: Bakhtiar Ui Islam
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001853:Bone Marrow / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D000072078:Positron Emission Tomography Computed Tomography; D011498:Protein Precursors / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D013921:Thrombocytopenia / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: Bone marrow; Carcinoma; Hepatocellular; Metastasis