A rare case of infiltrative hepatocellular carcinoma presented with neck mass

Abstract

Infiltrative hepatocellular carcinoma (HCC) has a poorer prognosis and is more difficult to diagnose compared to other HCC subtypes. The presented case is a man with metastatic infiltrative HCC presented with bilateral neck masses. This 57‐year‐old hepatitis B virus (HBV) carrier man had HBV infection under control with no evidence of liver cirrhosis. Initially, there was a slight elevation of alpha fetal protein (AFP). Abdominal CT showed an ill‐defined lesion at liver without triphasic character of HCC and multiple abdominal lymphadenopathies. Yet there was no portal vein thrombosis. Cholangiocarcinoma was first favored. Later on, bilateral neck masses were noted. Cervical mass biopsy showed positive HepPar1 by immunohistochemical (IHC) stain. Metastatic infiltrative HCC was diagnosed, and he started to receive sorafenib. The size of neck lymphadenopathy decreased after 3‐month therapy, but the AFP value remained stationary. Infiltrative HCC is hard to detect. We reported a rare infiltrative HCC case with atypical finding on image study and cervical lymph node metastasis in hope that it would bring a better understanding of the disease.