Skeletal metastases from hepatoma: frequency, distribution, and radiographic features.

Abstract

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

“…However, osteolytic lesions may not be detected on bone scintigraphy, and it has been known to be the pitfall of bone scintigraphy [25,29]. In this study, all bone metastases from HCC were osteolytic, and the detection rate of bone scintigraphy was low.…”

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

“…Soft-tissue masses are unique to BMs of HCC and have been observed in 39%-85.4% of patients [8,[18][19][20] . These Kuhlman et al [13] 1979-1985 300 22 (7.3) Liaw et al [14] 1983-1887 395 20 (5) Katyal et al [15] 1992-1997 403 148 (36.7) 41(10.2) 28 Fukutomi et al [3] 1978-1987 269 12 (4.5) 1988-1997 404 52 (12.9) Natsuizaka et al [5] 1995 soft-tissue masses can replace the normal bone matrix and exhibit expansive growth, frequently within the vertebral body. Paravertebral masses have been shown to grow inward to encapsulate and destroy the bone matrix [18] .…”

“…The incidence of BMs in HCC patients has been reported to be relatively low; 2%-12.9% in clinical studies, and 7.3%-38.5% in patients with extrahepatic metastases (Table 1) [2, 3,5,[13][14][15][16] . However, BM incidences of 10.2% and 12.9% were reported by Katyal et al [15] and Fukutomi et al [3] , respectively, which are higher than previously reported rates.…”

“…The reported incidence of skull metastases varies widely; 3.5%-30% [4,7,8,14] . Radiographically, typical BMs from HCC appear as expansible, destructive findings with large soft-tissue masses [13] . Most BMs are osteolytic and thus detectable using CT [14,19] (Figure 1).…”

“…Most BMs are osteolytic and thus detectable using CT [14,19] (Figure 1). However, HCC patients rarely exhibit either purely osteolytic or osteoblastic lesions [13,19] . Soft-tissue masses are unique to BMs of HCC and have been observed in 39%-85.4% of patients [8,[18][19][20] .…”