Year : 2003 | Volume
: 13 | Issue : 2 | Page : 165--167
Humerus metastasis revealing hepato-cellular carcinoma - a rare case report : MR findings
A Sharma, UK Makwana, D Jain, N Sharma
Department of Radio-diagnosis and Imaging, GB Pant Hospital and Maulana Azad Medical College, New Delhi-110002, India
C-10 Kendriya Vihar
Bone metastases from HCC are reported rare and especially in humerus. We report the MRI features of humeral metastasis from HCC in a 50 year old lady having pathological fracture humerus involving upper 1/3rd Part, with Involvement of muscles and soft tissue.
|How to cite this article:|
Sharma A, Makwana U K, Jain D, Sharma N. Humerus metastasis revealing hepato-cellular carcinoma - a rare case report : MR findings.Indian J Radiol Imaging 2003;13:165-167
|How to cite this URL:|
Sharma A, Makwana U K, Jain D, Sharma N. Humerus metastasis revealing hepato-cellular carcinoma - a rare case report : MR findings. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Jun 1 ];13:165-167
Available from: http://www.ijri.org/text.asp?2003/13/2/165/28654
Bone metastases infrequently appear as the first manifestation of hepatocellular carcinoma; and in any case in most patients the primary tumor is detected a few months after its development . The liver undergoes pathogenic changes such as hepatitis, fibrosis and cirrhosis under continuous stimulation by hepatitis virus or alcohol intake, leading to the development of HCC. The metstatic potential of HCC can be positively or negatively regulated by pathogenic alternations of liver .
A 50- year- old female presented with swelling in the right shoulder for the last 6 months. Plain x-ray shoulder joint revealed a pathological fracture in the upper 1/3rd part of the humerus. MR shoulder joint was performed on Gyro scan ACS NT RLI 1.5 T and T2-W3D FFE Sagittal, T2 WFFE axial, T1W TSE coronal and PDW TSE coronal sequences were obtained AIL the sequences revealed pathological fracture and involvement of the bone morrow of the humerus. Infiltration in subscapularis muscle, deltoid muscle, supraspinatus and teres minor was also demonstrated in all sequences. Axillary lymph nodal involvement was also present. [Figure 1],[Figure 2],[Figure 3],[Figure 4]. In the same sitting abdominal MR was also performed and BTFE portal (axial and coronal) images were obtained. It revealed a big mass lesion - iso - to hyper intense with increased hyper intense signals/foci involving right and left lobe in both the sequences [Figure 5][Figure 6]. MR Angiographic axial and coronal cuts show displaced portal vein and neo-vascularisation in the tumor region [Figure 7],[Figure 8]. Fine needle aspiration from humerus region revealed it to be metastatic lesion originating from HCC.
The occurrence of metastases is documented in a varied number of hepatocellular carcinomas. The indicative metastases is very rarely the form of clinical presentation of the disease . In the present case also, patient presented with a swelling in the shoulder joint as a clinical presentation of the disease. Similar two cases of HCC that were clinically presented in secondary location, in the bone and skeletal muscle respectively are described by Rosa JC et al (3). Borghetti M et al  reviewed bone metastasis of HCC and concluded that metastases from HCC are reported rarely and its incidence was observed only in 5.5% in 90 cases. Plain films demonstrate an osteolytic lesion without any surrounding sclerosis. CT shows destructive nature of these lesions with bulky soft tissue masses. Nobody has described MR findings in literature to the best of our knowledge in such type of lesion. Modern imaging like MR allow an early diagnosis and accurate staging can also be done. Sato M et al  have described role of US in peripheral bone metastasis in its five cases. Soto S et al  has suggested that with increased levels of alpha feto protein levels, intensified search of HCC and possible metastasis should be undertaken Hayashi K et al  reported a small metastasis from HCC associated with acute epidural hematoma on CT and MRI. Katyal S et al  reported extra hepatic metastasis of HCC in lungs, nodes and bone in their 403 cases series. Ha-Kawa SK et al  suggested that the treatment of bone metastasis is necessary for the relief of pain, and that care should be taken for prevention of fracture or paralysis, and that the control of the primary lesion is necessary for improving the chances of survival. Kaizu et al  concluded that radiation therapy was effective for bone metastasis for HCC; especially for those treated with TDF value of > or = 77. To conclude, HCC invasiveness is currently the major target of study and work in going or at the molecular level to localize biomarker of HCC progression as well as targets for intervention.
|1||Soto S, Artaza T, Gomez R, Camacho FI, Radriguez I: Rib metastasis revealing hepato-cellular Carcinoma. Scand J Gastro enterol.2000;35-3:333-336.|
|2||Katyal S, Oliver JH 3rd, Peterson MS, Ferris JV, Carr BS, Baron RL. Extra hepatic metastases of hepatocellular carcinoma. Radiology 2000: 216(3) : 698-703.|
|3||Rosa JC, Chaves P, de Almedia JM, Soares J. Hepato-cellular carcinoma. A Rare form of presentation. Acta Med Port1995: 4:243-245.|
|4||Borghetti M, Banelli G, Bonardi R, Reduzzi L, Lori M. Bone metastasis of hepato-carcinoma. Review of literature; radiological pictures and personal caseload. Radiol Med (Torino) 83 (1-2) 1999,48-5.|
|5||Sato M, Ishida H, Konno K et al. Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings. Abd Imaging 2001:26(5): 524-528.|
|6||Hayashi K, Matsuo T, Kurihara M, Daikoku M, Kitange G, Shibata S. Small metastasis of hepato-cellular carcinoma associated with acute epidural hematoma: a case report. Surg Neurol 53 (4) 2000, 379-82.|
|7||Ha-Kawa SK, Harima K, Tanaka Y et al. A clinical evaluation of distant metastases from hepatocellular carcinoma with reference to location, frequency, symptoms, treatment and prognosis. Gan No. Rinsho 1990;36(11)2012-2016.|
|8||Kaizu T, Karasawa K, Tanaka Y et al. Radiotherapy for osseous metastases from hepatocellular carcinoma: a retrospective study of 57 patients. Am J Gastroenterol 1998,93(11) 2167-2171.|