Metastatic Hepatocellular Carcinoma Masquerading as an Expansile Osteolytic Lesion in Scapula: A Rare Case of Isolated Appendicular Skeletal Metastatic Involvement of Hepatocellular Carcinoma at Initial Presentation

Abstract

Hepatocellular carcinoma (HCC) is known to be the most common primary tumor of the liver and is also the fifth most common cancer in the world. Chronic hepatitis B and C along with type 2 diabetes mellitus and alcoholic liver disease are quite well-known risk factors for HCC, and it is uncommon in the noncirrhotic liver. HCC favors spreading as multifocal intrahepatic lesions and potential vascular invasion, and extrahepatic spread is uncommon. Skeletal metastasis from HCC occurs infrequently compared to other cancers and is common in the axial skeleton. Metastatic involvement of the appendicular skeleton is a rare entity, and the initial presentation of HCC as metastatic involvement of the appendicular skeleton is even rarer. We report a case of HCC with incidentally detected cirrhosis and chronic hepatitis B infection presenting with pain in the left shoulder.