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Bukhari S, Ward K, Styler M. Hepatocellular Carcinoma: First Manifestation as Solitary Humeral Bone Metastasis. Case Rep Oncol Med 2020; 2020:8254236. [PMID: 33343953 PMCID: PMC7725568 DOI: 10.1155/2020/8254236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/22/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) most commonly presents with abdominal pain or mass, fever of unknown etiology, weight loss, and decompensation of known liver disease or at an asymptomatic stage through surveillance. Rarely, presenting symptoms can be exclusively related to extrahepatic metastases. Herein, we write a case of a patient with no known liver disease, presenting with a pathological fracture of the proximal humerus bone secondary to a massive solitary metastasis from HCC. This case represents an unusual appendicular skeletal metastasis in a patient with unknown primary HCC, successfully treated with sorafenib. The prognosis of HCC patients with extrahepatic metastasis is poor, and in the presence of bone metastases, the mean survival rate is severely reduced. However, the multikinase inhibitor sorafenib has been the standard of treatment. Recently, there has been developments of other therapeutic class of drugs (i.e., immune check inhibitors), which have shown promising benefits and better side effect profiles. Still, there is a need for further studies, owing to challenges in recognizing cellular and molecular markers.
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Affiliation(s)
- Sumera Bukhari
- Cambridge Health Alliance-Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine Ward
- Pennsylvania Hospital-Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Styler
- Fox Chase-Temple University Hospital, Philadelphia, Pennsylvania, USA
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Liaukovich M, Wu S, Yoon S, Schaffer J, Wang JC. Hepatocellular carcinoma presenting as spinal cord compression in Native Americans with controlled hepatitis C: two case reports. J Med Case Rep 2018; 12:282. [PMID: 30268151 PMCID: PMC6164177 DOI: 10.1186/s13256-018-1807-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/17/2018] [Indexed: 12/23/2022] Open
Abstract
Background Hepatocellular carcinoma is a common malignancy in Asia. It is associated with chronic hepatitis B virus or hepatitis C virus infection and alcoholic hepatitis. Commonly, the tumor metastasizes to the lungs, regional lymph nodes, and bone. Recently, the incidence of metastatic spinal cord compression caused by primary hepatocellular carcinoma has been reported more frequently due to improved diagnosis and therapeutic modalities. The presentation of primary hepatocellular carcinoma with spinal cord compression is very rare. To the best of our knowledge, there are only 33 such cases published to date. The majority of cases involve patients of Asian origin and are associated with hepatitis B infection. Case presentation We report consecutive cases of two Native American (American Indian) patients (a 64-year-old man and a 70-year-old man) who presented with symptoms of spinal cord compression due to metastatic spread of hepatocellular carcinoma and were associated with hepatitis C infection. In one of these cases, the hepatitis C infection had been successfully controlled (hepatitis C titers were undetectable for 1 year before he presented with spinal cord compression). This occurrence in a Native American with a controlled hepatitis C infection has not been reported previously. Conclusions Primary care physicians, oncologists, and gastroenterologists should be cognizant of this unusual presentation of hepatocellular carcinoma in a Native American. Such knowledge may help improve early diagnosis and survival.
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Affiliation(s)
- Maksim Liaukovich
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, 11212, USA
| | - Susan Wu
- Department of Pathology, South Naussau Communities Hospital, Oceanside, NY, USA
| | - Sydney Yoon
- Department of Radiology, South Naussau Communities Hospital, Oceanside, NY, USA
| | - Jeff Schaffer
- Department of Cardiology, South Naussau Communities Hospital, Oceanside, NY, USA
| | - Jen C Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, 11212, USA.
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Ayyadurai P, Badipatla KR, Chime C, Arjun S, Reddy P, Niazi M, Nayudu SK. Cervical Spinal Cord Compression: A Rare Presentation of Hepatocellular Carcinoma. Case Reports Hepatol 2017; 2017:8567695. [PMID: 28299213 PMCID: PMC5337315 DOI: 10.1155/2017/8567695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/18/2017] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver. Distant metastasis to various organs is well known. Skeletal metastasis is also reported to various locations. Vertebral metastasis has been reported mostly to thoracic spine. However, cervical spinal cord involvement leading to cord compression has been reported very rarely in literature. We present a case of 58-year-old male with liver cirrhosis presenting as neck pain. Further work-up revealed metastatic HCC to cervical spinal cord resulting in acute cord compression. Patient has been treated with neurosurgical intervention.
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Affiliation(s)
- Puvanalingam Ayyadurai
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Kanthi Rekha Badipatla
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Chukwunonso Chime
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Shiva Arjun
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
- American University of Caribbean, Cupecoy, Saint Martin
| | - Pavithra Reddy
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Suresh Kumar Nayudu
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Metastatic Spinal Cord Compression Secondary to Liver Cancer. Case Rep Neurol Med 2017; 2017:1679523. [PMID: 29230336 PMCID: PMC5688373 DOI: 10.1155/2017/1679523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/07/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
Abstract
Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression. The radiological and laboratory investigations done revealed the metastatic compression originating from a liver cancer with elevated alpha-fetoprotein and aspartate transaminase, positive hepatitis B surface antigen, and multiple metastasis in the lungs, mediastinum, ribs, iliac, and peritoneum. The hip joint X-ray showed a spontaneous fracture of the right femoral neck. The multidisciplinary treatment was palliative and the evolution was fatal within the month of hospitalization. Earlier diagnosis and treatment of MSCC may not have saved the life of the patient but may have prevented much suffering and would likely have prolonged the life of a young man.
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Goodwin CR, Yanamadala V, Ruiz-Valls A, Abu-Bonsrah N, Shankar G, Sankey EW, Boone C, Clarke MJ, Bilsky M, Laufer I, Fisher C, Shin JH, Sciubba DM. A Systematic Review of Metastatic Hepatocellular Carcinoma to the Spine. World Neurosurg 2016; 91:510-517.e4. [PMID: 27090971 PMCID: PMC5586495 DOI: 10.1016/j.wneu.2016.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data. METHODS We performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles that reported survival, clinical outcomes, and/or prognostic factors associated with patients diagnosed with spinal metastases. The methodologic quality of each review was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool. RESULTS There were 26 articles (152 patients) that met the inclusion criteria and were treated with either surgery, radiotherapy, chemotherapy, and/or observation. There were 3 retrospective cohort studies, 17 case reports, 5 case series, and 1 longitudinal observational study. Of the patients with known overall survival after diagnosis of spinal metastasis, survival at 3 months, 6 months, 1 year, 2 years, and 5 years was 95.2%, 83.0%, 28.6%, 2.0%, and 1.4%, respectively. The median survival after diagnosis of the metastasis was 0.7 months in the patients who received no treatment, 7 months in the patients treated with surgical intervention alone, 6 months for patients who received chemotherapy and/or radiation, and 13.5 months in the patients treated with a combination of surgery and medical management. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with HCC spinal metastasis have a 10.6-month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.
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Affiliation(s)
- C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Alejandro Ruiz-Valls
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ganesh Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Eric W. Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine Boone
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark Bilsky
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ilya Laufer
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Charles Fisher
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nangolo HT, Roberto L, Segamwenge IL, Voigt A, Kidaaga F. Spinal cord compression: an unusual presentation of hepatocellular carcinoma. Pan Afr Med J 2014; 19:363. [PMID: 25932076 PMCID: PMC4407935 DOI: 10.11604/pamj.2014.19.363.4323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 11/25/2014] [Indexed: 01/10/2023] Open
Abstract
Hepatocellular carcinoma is the 5th most common cancer in men and the 2nd common cause of death from cancer worldwide. The tumour commonly metastasizes to the lungs, regional lymph nodes and bone. Spinal cord compression secondary to metastatic disease as a first presentation is uncommon. We describe a patient who presented with paraplegia as a first presentation of hepatocellular carcinoma. 46 year old Namibian man presented with progressive leg weakness that was associated with a dull back ache and inability to pass urine and stool. He had no history of trauma nor did he have chronic cough, night sweats or fevers. He has been treated several times for alcohol dependence. On examination he was wasted, power 0/5 in both lower limbs and a sensory level at T12. He also had a non-tender hepatomegaly with Alpha-fetoprotein of 2000. The Chest X-ray and Chest CT showed nodular opacities indicating metastatic disease and the X-ray and CT of the thoracic spine showed osteolytic lesion with destruction of the pedicle of L1. Liver and spinal biopsy confirmed the hepatocellular carcinoma. The extra hepatic manifestations of HCC are diverse and Spinal cord metastasis is of pertinent clinical importance and should thus be greatly considered.
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Affiliation(s)
| | - Larrea Roberto
- Department of Internal Medicine, Intermediate Hospital Oshakati, Oshakati, Namibia
| | | | - Andreas Voigt
- Department Orthopedic Surgery, Intermediate Hospital Oshakati, Oshakati, Namibia
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Sherif KA, Frandah W, Graham S, Phy M. Hepatocellular carcinoma as unusual cause for paraplegia. J Clin Oncol 2012; 30:e303-5. [PMID: 22965954 DOI: 10.1200/jco.2012.42.8441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Metastatic hepatocellular carcinoma is a rare occurrence in the United States. The prognosis is poor, with a survival time of months from the time of diagnosis. This article reports a case of myelopathy that developed from metastases in a patient with no significant medical history. The patient was treated with decompressive laminectomy followed by adjuvant radiotherapy. A review of the literature demonstrated that most cases from hepatocellular carcinoma metastasizing to the spinal cord involve either the thoracic or lumbar levels and arise from the right liver lobe or both lobes. Major risk factors included positive hepatitis B virus serologies. This article also discusses current trends in management of epidural spinal cord compression. Although treatment with chemotherapy has not shown any benefit, surgical management has been shown to decrease morbidity and mortality in some patients.
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Somerset H, Witt JP, Kleinschmidt-Demasters BK. Hepatocellular carcinoma metastases to the epidural space. Arch Pathol Lab Med 2010; 133:1975-80. [PMID: 19961255 DOI: 10.5858/133.12.1975] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2009] [Indexed: 11/06/2022]
Abstract
Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain-especially with symptoms of paresthesia, radiculopathy, or cord compression-in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.
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Affiliation(s)
- Hilary Somerset
- Department of Pathology, University of Colorado Health Sciences Center, Aurora, CO 80045, USA
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Affiliation(s)
- Victor Ka-Siong Kho
- Division of Orthopedics, Department of Surgery, Far Eastern Memorial Hospital and Medical Center, Taipei, Taiwan, Republic of China
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Doval DC, Bhatia K, Vaid AK, Pavithran K, Sharma JB, Hazarika D, Jena A. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma. World J Gastroenterol 2006; 12:5247-52. [PMID: 16937544 PMCID: PMC4088031 DOI: 10.3748/wjg.v12.i32.5247] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.
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Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector-5, Delhi-110085, India.
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Abstract
HCC is the most frequent primary malignancy of the liver and one of the most common cancers in the world. HCC is substantially a complication of liver cirrhosis, and because HBV and HCV are the predominant causes of chronic liver disease and cirrhosis worldwide, they have a propensity to lead to HCC. Common sites of HCC metastases include the lung, lymph nodes, and portal vein. Bony metastases are rare, and when they do occur the disease is usually far advanced and is associated with clinical manifestations of abdominal pain, weight loss, jaundice, hepato-splenomegaly, ascities, deranged LFTs, and elevated AFP. We report here a patient with asymptomatic advanced HCC, normal LFTs, and normal AFP values presenting with spinal cord compression.
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Chang SS, Luo JC, Chao Y, Chao JY, Chi KH, Wang SS, Chang FY, Lee SD, Yen SH. The clinical features and prognostic factors of hepatocellular carcinoma patients with spinal metastasis. Eur J Gastroenterol Hepatol 2001; 13:1341-5. [PMID: 11692061 DOI: 10.1097/00042737-200111000-00013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Hepatocellular carcinoma is the most common malignancy in Taiwan, and spinal metastasis is a serious complication in cancer patients. In this study, we aimed to delineate the clinical features, evaluate the radiotherapy response and analyse the prognostic features in hepatocellular carcinoma subjects with spinal metastasis. METHODS From 1981 to 1997, 102 patients with spinal metastasis were enrolled, taken from the 5887 documented hepatocellular carcinoma patients treated at Taipei Veterans General Hospital. All the clinical and laboratory data were recorded, including: age; gender; liver biochemistry; tumour characteristics; Child-Pugh's score; performance status; number and location of vertebral metastasis; motor capacity; neurological symptoms and signs; response to radiotherapy of the spinal lesion; and survival. Prognostic factors in hepatocellular carcinoma patients with spinal metastasis were analysed using Cox's regression model. RESULTS The most common symptoms in hepatocellular carcinoma patients with spinal metastasis were lower back pain (74.5%), thoracic numbness (52.9%) and lower limb weakness (51.0%). Of the 102 patients, 84 received palliative radiotherapy using 3000 cGy for spinal lesions. Of these 84 patients, 32.1% showed a complete response, 26.2% a partial response and 41.7% a non-response to the radiotherapy. Multivariate Cox's regression analysis revealed that responsive radiotherapy (complete response + partial response) and good performance status (score <or= 2) were significant positive prognostic factors for survival in hepatocellular carcinoma patients with spinal metastasis. CONCLUSIONS Responsive radiotherapy can improve a hepatocellular carcinoma patient's quality of life by ameliorating the neurological condition and relieving pain, and can prolong survival in hepatocellular carcinoma patients with spinal metastasis.
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Affiliation(s)
- S S Chang
- Division of Gastroenterology, Taipei Veterans General Hospital, Taiwan
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Abstract
Spinal cord compression secondary to metastases is an infrequent complication of childhood cancer. We describe an infant with hepatoblastoma in whom cord compression developed because of extensive epidural metastases during treatment. This is a hitherto undescribed metastatic site for hepatoblastoma.
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Affiliation(s)
- M Jadhav
- Department of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit 48201, USA
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