Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 8, 2017; 9(22): 973-978
Published online Aug 8, 2017. doi: 10.4254/wjh.v9.i22.973
Extrahepatic metastasis of hepatocellular carcinoma to the paravertebral muscle: A case report
Kazuhiro Takahashi, Krishna G Putchakayala, Mohamed Safwan, Dean Y Kim
Kazuhiro Takahashi, Krishna G Putchakayala, Mohamed Safwan, Dean Y Kim, Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI 48202, United States
Author contributions: Takahashi K and Kim DY designed the report; Takahashi K, Putchakayala KG and Safwan M collected the data; Takahashi K and Kim DY wrote the paper; Putchakayala KG and Safwan M performed critical revisions of the paper.
Institutional review board statement: The case report was exempt from the Institutional Review Board standards at Henry Ford Hospital in Detroit.
Informed consent statement: The patient’s family gave written consent, authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: None of the authors have conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dean Y Kim, MD, Transplant and Hepatobiliary Surgery, Henry Ford Hospital, 2790 West Grand Boulevard, Detroit, MI 48202, United States. dkim3@hfhs.org
Telephone: +1-313-9162941 Fax: +1-313-9164353
Received: February 27, 2017
Peer-review started: February 28, 2017
First decision: April 18, 2017
Revised: April 29, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: August 8, 2017
Processing time: 160 Days and 21 Hours
Abstract

Identification of extrahepatic metastases (EHM) of hepatocellular carcinoma (HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography (CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, trans-catheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated image-guided radiation therapy (SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.

Keywords: Hepatocellular carcinoma; Skeletal muscle; Paravertebral muscle; Extrahepatic metastasis; Stereotactic hypo-fractionated image guided radiation therapy; Hepatitis B virus

Core tip: Extrahepatic metastases (EHM) of hepatocellular carcinoma (HCC) to skeletal muscle are extremely rare. We describe the first case of HCC with EHM to the paravertebral muscle, in which stability of disease was achieved using stereotactic hypo-fractionated image-guided radiation therapy. A literature review revealed the strong relationship between hepatitis B viral infection and EHM. This case highlights the importance of early detection of viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.