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01.12.2012 | Case report | Ausgabe 1/2012 Open Access

World Journal of Surgical Oncology 1/2012

A pathological fracture and a solitary mass in the right clavicle: an unusual first presentation of HCC and the role of immunohistochemistry

World Journal of Surgical Oncology > Ausgabe 1/2012
Eleftherios I Mantonakis, Theodora S Margariti, Athanasios S Petrou, Anastasios C Stofas, Andreas C Lazaris, Alexandros E Papalampros, Demetrios N Moris, Panagiotis O Michail
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1477-7819-10-50) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

EIM, TSM and ASP collected and reviewed the data regarding the patient presented and wrote the paper. AEP and DNM were responsible for reviewing the literature and relating its findings with our case. ACS and ACL were responsible for the pathology report and its findings presentation. POM was responsible for reviewing the final format and editing of the article. All authors read and approved the final manuscript.


Hepatocellular carcinoma (HCC) is an aggressive malignant tumor that occurs throughout the world. Μetastases from hepatocellular carcinoma (HCC) were generally considered to be rare in the past, because the carcinoma had an aggressive clinical course. In our era, has been reported that extra-hepatic metastases occur in 13.5%-41.7% of HCC patients and this is considered as terminal-stage cancer. The prognosis for patients at this stage continues to be poor due to limited effective treatment. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. We present here an extremely infrequent case of a patient, without known liver disease, in which the presenting symptom was a pathological-in retrospect-fracture of his right clavicle which wasn't properly evaluated, until he presented a bulky mass in the region 6 months later. For our patient, the added diagnostic difficulty alongside the unknown liver disease, has been that the clavicular metastases was the first presentation of any metastatic disease, rather than the more common sites of HCC spread to adjacent lung or lymph nodes.
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