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Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass.

Gupta R, Hirsch J, Guhan M, Triska J, Hernaez R, Taylor A. Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass. Oncology (Williston Park, N.Y.). 2023 Aug 8; 37(8):335-338.

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Abstract:

BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer worldwide. Extrahepatic spread is not unusual during HCC disease, but bone metastases at initial presentation are rare. CASE DESCRIPTION: We describe a case of HCC presenting with a clavicular head mass and spinal metastases with normal a-fetoprotein (AFP) level and hepatitis C virus infection without cirrhosis. After undergoing bone and liver biopsies, the patient started a 12-week course of sofosbuvir/velpatasvir and bevacizumab/atezolizumab for lifelong therapy with palliative intent. Since 2021, the patient has been receiving a combination of bevacizumab and atezolizumab every 21 days. On this regimen as of March 2023, his osseous metastases were stable and his liver lesions had not enlarged. CONCLUSIONS: This case demonstrates a very unusual HCC presentation, the importance of a thorough workup of bone metastasis, and the limited value of AFP for HCC screening, even in disseminated disease.




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