Medicina, Vol. 52 No. 2, 2016.
Recenzija, Prikaz slučaja
Sacral metastasis of hepatocellular carcinoma – the only manifestation of the disease
Zrinka Matana Kaštelan
; Katedra za radiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Tiana Grubešić
; Klinički zavod za radiologiju, KBC Rijeka, Rijeka
Berislav Budiselić
; Katedra za laboratorijsku i radiološku dijagnostiku, Fakultet zdravstvenih studija, Sveučilište u Rijeci, Rijeka
Sandra Milić
; Katedra za internu medicinu, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Davor Štimac
; Katedra za internu medicinu, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Damir Miletić
; Katedra za radiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka
Sažetak
Aim: Rare patients with advanced hepatocellular carcinoma (HCC) exclusively present with symptoms of distant metastasis. If there is no histological confirmation of the disease from liver tissue sample, extrahepatic lesion biopsy can confirm or exclude clinical suspicion. Case report: A 57-year-old male with long history of hepatitis C infection underwent computed tomography (CT) and magnetic resonance (MR) imaging which revealed nodular liver rearrangement with thrombosis of the right portal vein branch. Large intrahepatic HCC with vascular invasion was suspected, although without clear demarcation on imaging or histological verification. Only severe cirrhosis was found in several biopsy specimens. Since the patient suffered from simultaneous chronic lower back pain, and paresthesia with incontinence emerged, he underwent pelvic MR which demonstrated osteolitic destruction and large soft tissue mass in the sacrum. CT-guided biopsy confirmed HCC metastasis. Supraselective embolization of irrigating lateral sacral arteries was performed. Conclusion: Diagnosis of HCC sometimes can be challenging despite diagnostic procedures performed in accordance with current guidelines. In our patient sacral lesion was the only detectable metastasis of HCC and the target for histological confirmation of the disease. In patient with clinical suspicion on HCC but without histological confirmation from liver tissue, detection and biopsy of distant metastases is the only way to diagnose the disease.
Ključne riječi
biopsy; bone metastasis; diagnostic imaging; hepatocellular carcinoma
Hrčak ID:
158637
URI
Datum izdavanja:
1.6.2016.
Posjeta: 3.376 *