Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
Diagn Cytopathol. 2022 Jul;50(7):335-340. doi: 10.1002/dc.24961. Epub 2022 Apr 11.
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and it may present initially with extrahepatic spread in 5%-15% cases. It most commonly metastasizes to lungs, lymph nodes and adrenal glands. Skeletal metastases from HCC are uncommon and carry a very poor prognosis.
We retrospectively reviewed all fine needle aspiration (FNA) specimens of metastatic HCC at our institution from January 1994 to March 2021 using the SNOMED search computer option. Relevant clinical information was obtained from the review of patient's electronic medical records.
There were 36 FNAs of metastatic HCC over a period of 27 years. Six patients (16.7%) were found to have skeletal metastases. All six patients were males with a median age of 59 years (54-71 years) and their lesions were osteolytic. The most common site of metastases was vertebra (3/50%). Most patients (67%) had bone metastases as an initial presentation, without prior history of HCC. The mean survival after the diagnosis of skeletal metastases was only 8 months.
Detection of extrahepatic HCC to bone is important to avoid any unwanted surgical intervention. In our patient population, the most common site of skeletal metastases from HCC was vertebra, therefore in FNAs of vertebral lytic masses, metastatic HCC should be considered. On FNA, extrahepatic metastases of HCC can mimic other poorly differentiated tumors. They behave in an aggressive fashion, resulting in a grim prognosis. Cytological substrates can be used for future molecular testing, if needed.
肝细胞癌 (HCC) 是全球最常见的癌症之一，有 5%-15%的病例在初始时就有肝外扩散。它最常转移到肺部、淋巴结和肾上腺。HCC 的骨骼转移并不常见，预后非常差。
我们使用 SNOMED 搜索计算机选项，回顾了 1994 年 1 月至 2021 年 3 月在我们机构进行的所有转移性 HCC 的细针穿刺 (FNA) 标本。通过回顾患者的电子病历获得了相关的临床信息。
在 27 年的时间里，有 36 例转移性 HCC 的 FNA。有 6 名患者（16.7%）被发现有骨骼转移。这 6 名患者均为男性，中位年龄为 59 岁（54-71 岁），病变为溶骨性。转移最常见的部位是椎体（3/50%）。大多数患者（67%）以骨转移为首发表现，且无 HCC 病史。在诊断为骨骼转移后，平均生存时间仅为 8 个月。
检测 HCC 向肝外骨骼的转移对避免不必要的手术干预很重要。在我们的患者人群中，HCC 骨骼转移最常见的部位是椎体，因此在椎体溶骨性肿块的 FNA 中，应考虑转移性 HCC。在 FNA 中，HCC 的肝外转移可模仿其他低分化肿瘤。它们表现出侵袭性，导致预后不佳。如果需要，细胞学基质可用于未来的分子检测。
