Abstract:
Introduction:
Acrometastasis occur infrequently, accounting for approximately 0.1% of all
metastatic osseous involvement. Its presentation mimics infectious or inflammatory disease.
Primary presentation of HCC as bone metastasis is rare
. When present, they are mostly
vertebral, rib or skull deposits. Primary manifestation of HCC as acrometastasis is extremely
rare.
Case Report:
A 59 year old alcoholic male was admitted with sudden onset profuse bleeding
from an ulcer involving middle and
proximal phalanx of left middle finger. This was a
chronic wound following a road traffic accident. Patient underwent amputation of this finger
for the clinical diagnosis of chronic osteomyelitis. Macroscopy of amputated finger showed a
continuous lesion
from skin to bone with evidence of bone destruction. Microscopy together
with immunohistochemistry (HepPa 1
antibody)
confirmed a deposit of a HCC with skin and bone infiltration. Follow up radiological investigations revealed two foci of hepatocellular
c
arcinoma with background cirrhosis.
Discussion:
HCC show a haematogenous spread usually via pulmonary circulation and
vertebral circulation. Hence the mechanism of spread into bones other than the bones of the
axial skeleton, bypassing the lung is not expl
ained. Amputation, radiation, excision, and
systemic therapy are the available treatment options. Radiotherapy is an effective and non
-
invasive treatment that improves patient’s quality of life. When patients present with lytic
lesions of the bone consider
ing a deposit of a HCC despite the site will be helpful to complete
the preoperative work up with a USS of abdomen. The presence of acrometastasis in patients
with cancer helps staging the disease and usually indicates a very poor prognosis.