Liu Kuang-Ting, Chang Yueh-Ching, Lin Yu-Chieh, Chang Junn-Liang
Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital.
Hsin Sheng Junior College of Medical Care and Management.
Ann Med Surg (Lond). 2024 Jun 25;86(9):5501-5508. doi: 10.1097/MS9.0000000000002307. eCollection 2024 Sep.
Hepatocellular carcinoma (HCC) is a highly malignant primary hepatic tumor. However, extrahepatic metastatic sites of HCC with post-therapy dissemination of metastases mimicking primary soft tissue sarcomas with rib metastases are extremely rare.
The authors report a unique case of hepatitis B virus (HBV)-positive HCC with bilateral lung involvement and widespread right-flank soft tissue and rib metastases. The pathological diagnosis after surgical resection confirmed extrahepatic HCC metastasis. Subsequently, adjuvant-targeted and immune-checkpoint inhibitor therapies were still initiated.
Extrahepatic HCC metastasis, which initially presents at distant sites, is uncommon. HCC commonly metastasizes to the lungs, bones, lymph nodes, kidneys, adrenal glands, and peritoneum/omentum. HCC with aggressive post-scheduled adjuvant therapy to the lungs and hypochondriac soft tissue with rib metastasis is very rare and has a poor prognosis.
Although most patients with HCC have disseminated extrahepatic metastases, primary HCC should still be treated. Thus, a review of the history and imaging, histopathology, and immunohistochemical findings is crucial for the definite and differential diagnosis of this tumor.
肝细胞癌（HCC）是一种高度恶性的原发性肝脏肿瘤。然而，HCC发生肝外转移且转移灶在治疗后播散，类似原发性软组织肉瘤伴肋骨转移的情况极为罕见。
作者报告了一例独特的乙型肝炎病毒（HBV）阳性HCC病例，双侧肺受累，右侧胁腹软组织及肋骨广泛转移。手术切除后的病理诊断证实为肝外HCC转移。随后，仍启动了辅助靶向治疗和免疫检查点抑制剂治疗。
肝外HCC转移最初出现在远处部位，较为罕见。HCC通常转移至肺、骨、淋巴结、肾、肾上腺及腹膜/大网膜。HCC伴对肺及季肋部软组织伴肋骨转移进行积极的术后辅助治疗的情况非常罕见，预后较差。
尽管大多数HCC患者已发生肝外转移播散，但原发性HCC仍应进行治疗。因此，回顾病史、影像学、组织病理学及免疫组化结果对于该肿瘤的明确诊断和鉴别诊断至关重要。
