Intramuscular recurrence in a Hepatocellular carcinoma patient with indolent disease course
© Yau et al; licensee BioMed Central Ltd. 2008
Received: 26 February 2008
Accepted: 23 April 2008
Published: 23 April 2008
Hepatocellular carcinoma (HCC) is a common malignancy worldwide and treatment options are depended on the stage of the tumour. In general, the prognosis of HCC patients with extra-hepatic metastasis is poor. The most common sites of extra-hepatic metastasis are the lung, abdominal lymph nodes and bone.
Here, we reported a 54-year-old man with an indolent clinical course of HCC. He had multiple extra-hepatic recurrences after initial hepatectomy for HCC and was benefited from repeated resections with prolonged survival. Eventually, he developed intramuscular recurrence in the thigh, which was initially mistaken as deep vein thrombosis.
Selected patients with indolent disease course of HCC may benefit from repeated resections of extra-hepatic metastases with prolonged survival.
Hepatocellular carcinoma (HCC) is a common malignancy worldwide, especially in Southeast Asia where viral hepatitis is prevalent. Treatment options and thus prognosis are highly variable depending on the stage of the tumor. The prognosis of HCC patients with extra-hepatic metastasis is generally poor. The most common sites of extra-hepatic metastasis are the lung, abdominal lymph nodes and bone . Rarely, HCC has been reported to metastasize to the breast , pituitary gland , gingiva and papillary muscle of the heart . Intramuscular metastasis from HCC is indeed very rare. Here, we reported a 54-year-old patient with an indolent and interesting clinical course of HCC.
To our knowledge, there are only very few reports in the literature regarding intramuscular HCC metastasis thus far [5, 6]. In fact, despite the rich vascular supply of the muscle, it is rarely a site of metastasis in cancer patients . This interesting phenomenon may be due to the contractility action of muscle, its local pH environment, and accumulation of lactic acid and other metabolites in the muscle .
The patient presented with a thigh metastasis. The other differential diagnosis in this case is deep venous thrombosis as HCC patients are found to have an increased risk for thromboembolism . However, deep vein thrombosis is in fact a rare manifestation of hypercoagulable state in HCC patients.
In the present case, the patient has an indolent disease course of advanced HCC. His overall survival is largely enhanced by aggressive multiple resections of all the extra-hepatic sites of recurrence until finally the disease became widespread with involvement of the rare site of thigh muscle. In fact, in the literature, it is well recognized that treatment for extra-hepatic recurrence is important in prolonging survival especially in patients with well-controlled primary . However, there is no convincing evidence to suggest that aggressive surgical resection of metastases from primary HCC is beneficial to all patients with metastatic HCC, albeit some studies suggested the benefits of such approach in highly selected HCC patients with distant metastases . Nowadays, instead of aggressive metastatectomy, a novel multi-targeted kinase inhibitor – sorafenib offers new hope to this group of patients with unresectable metastases as it was shown to improve the overall survival with tolerable toxicities .
Selected patients with indolent disease course of HCC may benefit from repeated resections of extra-hepatic metastases with prolonged survival. Eventually, the disease may develop recurrence in rare sites as illustrated in the present case and cause dilemma in the diagnosis and management.
A written informed consent was obtained from the patient for publication of this case report and any accompanying images.
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