Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

MUSCULOSKELETAL
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

Correspondence Address:
A Sharma
C-10 Kendriya Vihar
India

Abstract

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 2019 Aug 25 ];13:165-167
Available from: http://www.ijri.org/text.asp?2003/13/2/165/28654


Full Text

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 [1]. 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 [2].

 Case Report



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.

 Discussion



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 [3]. 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 [4] 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 [5] have described role of US in peripheral bone metastasis in its five cases. Soto S et al [1] 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 [6] reported a small metastasis from HCC associated with acute epidural hematoma on CT and MRI. Katyal S et al [2] reported extra hepatic metastasis of HCC in lungs, nodes and bone in their 403 cases series. Ha-Kawa SK et al [7] 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 [8] 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.

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