Acrometastasis as the initial presentation of Hepatocellular Carcinoma (HCC)

Abstract

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Introduction: Acrometastasis occur : infrequently, accounting for approximately 0.1% of all metastatic osseous involvement. Its presentation nrimics 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 art 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 carcinoma 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 explained. 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 considering a deposit of a HCC despite the site will be helpful to complete tire 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.