Undiagnosed Hepatocellular Carcinoma Presenting as Nasal Metastases

Abstract

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver with up to half of cases suffering from extrahepatic metastasis in the later stages of the disease. Commonly reported and encountered metastatic sites include the lymph nodes, lung, bone, and adrenal glands. This is an effort to throw a spotlight on a rare case of metastatic HCC which presented to us as two distinct lesions in the nose. It focuses on the presentation and the steps that were taken to reach this rare and unusual diagnosis. It sparks interest from a clinical and histopathology perspective. Our cynosure is the findings of the case coupled with a probe on the possible routes of spread of HCC to sinonasal region.

Advanced‐stage hepatocellular carcinoma presenting without radiographic liver lesions

“…Interestingly, in all the reported cases of extrahepatic HCC, without liver primaries, the subjects were all hepatitis C positive , unlike our patient. Other cases reported of unusual presentations of HCC have had some unusual finding on liver imaging corresponding with the time of or prior to diagnosis, unlike our patient who developed lesions after confirmed diagnosis and treatment had been initiated .…”

Shoulder Mass as the Initial Presentation of Metastatic Hepatocellular Carcinoma

“…Extrahepatic metastatic HCC, as observed in this case, occur in 30–50% of HCC patients; the most common sites are lungs, bones, adrenal glands, and lymph nodes 4. Rare and unusual metastatic sites have been described in the literature, including the chest wall presenting as a breast mass and metastasis to the nasal septum 5,6. Indeed, extrahepatic metastases to the humeral shoulder, chest wall, and bony lesions are exceedingly rare, as only a handful of cases have been reported 3,7.…”

“… 4 Rare and unusual metastatic sites have been described in the literature, including the chest wall presenting as a breast mass and metastasis to the nasal septum. 5 , 6 Indeed, extrahepatic metastases to the humeral shoulder, chest wall, and bony lesions are exceedingly rare, as only a handful of cases have been reported. 3 , 7 Traditionally, a few systems have been widely employed for HCC staging (e.g.…”

<p>Rare Site Hepatocellular Carcinoma Metastasis</p>

“…The proposed route for RSHM is the spread of malignant cells via the hepatic veins to caval venous system through the pulmonary circulation and then into arterial vessels. 8 Once the malignant cells reach the arterial circulation, HCC metastasis may theoretically be found everywhere. To the best of our knowledge, this is the first report of the nail-bed as a HCC metastatic site.…”