Hepatocellular carcinoma is a highly malignant neoplasm. Extrahepatic metastases are found in 64% of patients with hepatocellular carcinoma. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of metastases. Pancreatic metastases are not common (<5%). A case report of a hepatocellular carcinoma with a metastasis in the distal pancreas is presented. A resection of the primary tumour and metastasis was carried out with the patient still alive 16 months after resection. This case illustrates that hepatic resection for hepatocellular carcinoma with a single local metastasis can be reasonably considered although a cure has not been established.

Mycobacterial infections are rare in developed countries. Isolated involvement of the liver and biliary tree by mycobacterial infection is extremely rare. We report a case of a 45-year-old Caucasian female presenting with obstructive jaundice with a common bile duct stricture and multiple hypodense liver lesions raising suspicion of a metastatic cholangiocarcinoma. Percutaneous core biopsies of the liver lesions however suggested granulomatous process and histology at surgical excision confirmed this finding. Atypical mycobacteria (M. abcessus) sensitive to Amikacin were cultured from the surgical specimen proving the diagnosis. With the resurgence of tubercular and atypical mycobacterial infections in the developed world, it is important not to overlook these in differential diagnosis of various malignancies.

SummaryA fatal case of extensive skin ulceration and infarction with metastatic calcification in the cutis, subcutis, and vessels is presented in an Aboriginal woman with chronic renal failure and secondary hyperparathyroidism. Parathyroidectomy and debridement of skinulcers with grafting were performed, but the patient died of septicaemia. Heparin induced necrosis was considered in the differential diagnosis and excluded.