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Case Report

Hepatocellular carcinoma presenting as rapidly growing sternal mass:
an unusual presentation

Rahul S. Kulkarni, Asha S. Anand, Apurva A. Patel, Sandip A. Shah
Department of Medical and Paediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad 380016, Gujarat, India.
Correspondence to: Dr. Rahul S. Kulkarni, Department of Medical and Paediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad
380001, Gujarat, India. E-mail: dr.rsk08@gmail.com

A B S T R AC T
Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. The most frequent sites of metastases are lungs,
regional lymph nodes, adrenals and bones. However, an isolated sternal metastasis from HCC as an initial presentation has been
rarely reported. A 45-year-old man presented with a progressively increasing mass over the anterior chest wall. On investigations,
it was found to be arising from the sternum. Histopathology was suggestive of metastatic HCC, later confirmed by the presence
of a 9 cm × 7 cm mass in the liver on abdominal computed tomography scan and a significantly elevated serum alpha fetoprotein
level. Thus, metastasis from HCC should be included in the differential diagnosis of anterior chest wall mass and rapidly growing
osseous metastases at unusual sites, even in the absence of signs of liver disease.

Key words: Bony metastasis, hepatocellular carcinoma, sternal mass

INTRODUCTION 2-3 months. There was no history of fever, jaundice,
abdominal pain, loss of appetite and weight. Personal and
Hepatocellular carcinoma (HCC) is the most common family history was not significant.
primary malignant tumor of the liver. It commonly occurs
in the 6th and 7th decades of life in the western countries On examination, there was an 8 cm × 6 cm mass
whereas in Asia it is more common in the 4th and 5th over the sternum, immobile and firm with no local rise of
decades. Chronic viral hepatitis, particularly hepatitis B, has temperature. The overlying skin was tense, with dilated
been the most common etiological factor. Hematogenous veins over the mass [Figure 1]. The remainder of the
[1]
extra-hepatic metastases are commonly seen in lungs, physical examination was unremarkable.
lymph nodes, kidneys, adrenals, and bones. Though bone
metastasis may occur in around 10% cases with HCC, the Routine blood investigations including hemogram and
most frequent sites are vertebrae and pelvis, rarely sternum renal function tests were normal. However, liver function
or ribs. However, isolated sternal metastasis as the initial tests were altered, showing increased transaminases and
[2]
presentation of HCC has been rarely reported. We hereby alkaline phosphatase [Table 1]. Human immunodeficiency
report a case of a 45-year-old man who presented with virus and hepatitis C virus were negative. However, the
progressively increasing anterior chest wall swelling, which patient was found to be hepatitis B surface antigen-positive.
was diagnosed to be sternal metastasis from incidentally
diagnosed HCC. Fine needle aspiration cytology (FNAC) from the mass
showed cellular smears highly suspicious of malignancy.
CASE REPORT Hence, computed tomography (CT) of thorax was done
which revealed a 67 mm × 47 mm expansile, osteolytic
lesion with destruction and markedly enhancing soft
A 45-year-old male presented to our hospital with chief
complaints of progressively increasing swelling over tissues involving the manubrium, suggestive of malignant
the anterior chest wall, associated with mild pain for
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How to cite this article: Kulkarni RS, Anand AS, Patel AA, Shah SA.
Hepatocellular carcinoma presenting as rapidly growing sternal mass:
DOI: an unusual presentation. J Cancer Metastasis Treat 2016;2:41-3.
10.4103/2394-4722.169643
Received: 21-05-2015; Accepted: 21-10-2015.

© 2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 41