P1061 - Unusual Presentation of Metastatic Hepatocellular Carcinoma

Miguel Vives, MD, Mario Robles, MD
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Primary liver cancer is the seventh most frequently occurring cancer in the world, with Hepatocellular carcinoma (HCC) being responsible for around 75-85% of cases. Early detection has resulted in lower mortality however, it still presents diagnostic and therapeutic challenges to physicians all over the world. Metastasis often occurs in lung and regional lymph nodes however, metastatic disease to the peripheral nervous system is not as common.

Case Description/Methods: In this case, we present a 72-year-old man with a past medical history of HIV, Cirrhosis, HCV, Hepatocellular carcinoma S/P multiple TACE in remission and esophageal varices who initially presented due to painful bright red blood per rectum the day of admission. Assessment of rectal bleeding was attributed to hemorrhoids. During hospitalization patient referred low back, and right leg pain with decreased sensation in extremitiy within the last month. Pelvis MRI with contrast demonstrated a heterogeneously enhancing encapsulated sausage-like right pelvic mass extending through the sciatic foramen along the course of the sciatic nerve into the right posterolateral hip with tumor invasion of the sacrum and obliteration of the sacral spinal canal, highly suggestive of an aggressive/malignant neurogenic tumor. Immunostains were positive for Arginase and Hepatic specific antigen (HSA). Pathology report from lesion, compatible with metastatic hepatocellular carcinoma. Metastatic disease presents also in cervical, and thoracic vertebral bodies. Palliative radiotherapy started as well as sorafenib given the advanced condition. Within the following month, comfort care started as per the patient’s desire.

Discussion: HCC metastatic disease results in significant morbidity and mortality in affected patients. This case sheds light upon broad symptomatology and a wide range of presentations of metastatic disease. Surveillance after HCC treatment continues to be one of the cornerstones of management and usual complications of underlying liver disease are well documented and evaluated by clinicians. This case illustrates how metastatic disease can be overlooked when subtle symptomatology is present. Low back pain is one of the most common complaints when visiting an emergency room and is sometimes dismissed as benign when in fact can be secondary to an aggressive metastatic lesion that requires prompt interventions.


Disclosures:


Miguel Vives, MD, Mario Robles, MD. P1061 - Unusual Presentation of Metastatic Hepatocellular Carcinoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.