[Shoulder metastasis as the initial manifestation of hepatocellular carcinoma (HCC)]

Primary diagnosis of hepatocellular carcinoma (HCC) by a shoulder metastasis is a rare event.

A 68-year-old man was admitted with swelling of his left shoulder. No further clinical symptoms. Alcohol consumption: 1 l beer/day. On ultrasound, the clinically impressing tumor of the left shoulder showed calcifications.

Histologic examination of the tumor of the shoulder showed a well-differentiated, trabecular carcinoma consistent with the metastasis of an HCC. Subsequent ultrasound of the abdomen gave evidence of liver cirrhosis. In addition, an infiltrating mass was found, which encompassed 75% of the right liver lobe and was subsequently shown by histology to be a well-differentiated HCC with identical features of the tumor of the shoulder. Further metastases with pathologic rib fractures were found on CT scan of the thorax.

Based on clinical findings, laboratory investigations and imaging studies, the patient suffered from an HCC owing to ethyl-toxic liver cirrhosis stage Child C, and initially presented with a shoulder metastasis.

Due to the advanced tumor stage, no curative or palliative therapy was administered.

This is an interesting case of an atypical primary diagnosis of HCC. The most important information was given by the pathologists who raised the suspicion of a metastasizing HCC by examining the tumor of the shoulder.