Cervical spinal metastasis of unsuspected hepatocellular carcinoma on initial presentation

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Abstract Introduction/Objective In this case, a 66-year-old female reported to the emergency room (ER) for severe worsening neck and shoulder pain bilaterally for one month. Associated symptoms included bilateral hand weakness, swelling of the hands, inability to pick up objects, and inability to press buttons. MRI and CT scan of the spine demonstrated irregular marrow signals within C5, C6, and C7 vertebral bodies associated with anterior epidural thickening and the C6 vertebral body extending along C4-C5 nerve roots. Further imaging demonstrated a distended hepatic lesion measuring 6.3 x 6.4 x 6.9 cm. CT-guided biopsy of right hepatic lobe mass was performed. The cuboidal tumor cells showed abundant clear cytoplasm and centrally located nuclei demonstrated high nuclear:cytoplasmic ratio, and trabecular architecture. Tumor was immunoreactive to CK-7, CK-20, and Hep par 1, consistent with HCC. The Ki-67 proliferative activity is at 10%. Additionally, AFP, Napsin A, Pax 8, and RCC stains were negative. CT- guided biopsy of the longus colli muscle and anterior cervical spine at the C6 vertebrae performed at the same time demonstrated tumor positive for Hep par 1, consistent for metastatic HCC from just established liver primary. Bone metastasis of hepatocellular carcinoma (HCC) on initial presentation is rare, with an incidence rate of 0.9%. Of these cases, most incidents involve the vertebrae, pelvis, ribs, and skull, with poor patient morbidity and mortality. The thoracic and lumbar spinal locations are common in the field of view of standard abdominal imaging protocols and possibly are the most commonly reported regions of HCC spinal metastasis. Methods/Case Report Case report. Results (if a Case Study enter NA) NA Conclusion This case report demonstrates an unusual clinical presentation of spinal radiculopathy initially thought secondary to degenerative changes, which led to additional diagnostic imaging revealing a hepatic mass biopsied positive for hepatocellular carcinoma with metastasis to the spine.

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