title: Mastalgia as an atypical presentation of hepatocellular carcinoma: a case report.
abstract: BACKGROUND
  As the incidence of hepatocellular carcinoma (HCC) diagnoses in Saudi Arabia has recently increased due to better diagnostic techniques, the incidence of diagnosed HCC metastasis has also increased. Here, we report a case of HCC metastasis to the rib with an initially atypical presentation of mastalgia caused by extrahepatic metastasis.
  
  
  METHODS
  A 31-year-old woman with a prior hepatitis B viral infection presented with a mass in the left breast accompanied by mastalgia for a 6-month duration. The patient's liver enzymes were elevated, and her serum α-fetoprotein level was particularly high. Computed tomography of her chest and abdomen showed a soft-tissue mass adhering to the upper chest wall, rib deterioration, and multiple hepatic lesions. A needle biopsy was immunohistochemically analyzed for Glypican-3, Pan-CK, and CK7 and was confirmed to be metastatic HCC.
  
  
  CONCLUSIONS
  This metastatic HCC case is unique because it initially presented as mastalgia. We should consider the possibility of metastatic disease when assessing patients with unusual presentations who have risk factors for metastatic carcinoma.
authors.affiliation: Department of Radiology, King Fahd Hospital of the University, University of Dammam, P.O. Box 4398, 31952, Dammam, Eastern Province, Saudi Arabia. amsharydah@uod.edu.sa.
authors.forename: AbdulAziz Mohammad
authors.initials: AM
authors.lastname: Al-Sharydah
authors.affiliation: Department of Radiology, King Fahd Hospital of the University, University of Dammam, P.O. Box 4398, 31952, Dammam, Eastern Province, Saudi Arabia.
authors.forename: Abdulrhman Hamad
authors.initials: AH
authors.lastname: Al-Abdulwahhab
authors.affiliation: Department of Radiology, King Fahd Hospital of the University, University of Dammam, P.O. Box 4398, 31952, Dammam, Eastern Province, Saudi Arabia.
authors.forename: Ibrahim Abobaker
authors.initials: IA
authors.lastname: Alghnimi
authors.affiliation: Department of Pathology, King Fahd Hospital of the University, University of Dammam, Dammam, Eastern Province, Saudi Arabia.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: El Shawarby
authors.affiliation: Department of Emergency Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Eastern Province, Saudi Arabia.
authors.forename: Faisal Ahmad
authors.initials: FA
authors.lastname: Katbi
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery; D059373:Mastodynia / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis
keywords: Bone metastasis; Extrahepatic; Liver cancer; Metastatic hepatocellular carcinoma