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.
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.
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.
Ministry of Health National Cancer Registry. Cancer Incidence Report-Saudi Arabia 1994–2010. 2014. ISSN: 1658-0559. http://www.chs.gov.sa/Ar/mediacenter/NewsLetter/2010%20Report%20(1).pdf.
Goldman L, Ausiello DA, editors. Cecil medicine. Philadelphia: Saunders Elsevier; 2008.
Si MS, Amersi F, Golish SR, Ortiz JA. Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival. Am Surg. 2003;69(10):879. PubMed
Uka K, Aikata H, Takaki S, Shirakawa H, Jeong SC, Yamashina K, Hiramatsu A, Kodama H, Takahashi S, Chayama K. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol. 2007;13(3):414. doi: 10.3748/wjg.v13.i3.414. CrossRefPubMedPubMedCentral
Yang Y, Nagano H, Ota H, Morimoto O, Nakamura M, Wada H, Noda T, Damdinsuren B, Marubashi S, Miyamoto A, Takeda Y. Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery. 2007;141(2):196–202. http://dx.doi.org/10.1016/j.surg.2006.06.033. CrossRefPubMed
Zaakook M, Ayoub M, Sinna EA, El-Sheikh S. Role of glypican-3 immunocytochemistry in differentiating hepatocellular carcinoma from metastatic carcinoma of the liver utilizing fine needle aspiration cytology. J Egypt Natl Canc Inst. 2013;25(4):173–80. http://dx.doi.org/ 10.1016/j.jnci.2013.07.004. CrossRefPubMed
Katyal S, Oliver III JH, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma 1. Radiology. 2000;216(3):698–703. http://dx.doi.org/10.1148/radiology.216.3.r00se24698. CrossRefPubMed
- Mastalgia as an atypical presentation of hepatocellular carcinoma: a case report
AbdulAziz Mohammad Al-Sharydah
Abdulrhman Hamad Al-Abdulwahhab
Ibrahim Abobaker Alghnimi
Mohammed A. El Shawarby
Faisal Ahmad Katbi
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II