Hepatocellular carcinoma presenting with the superior mediastinal syndrome

Two southern African black men with hepatocellular carcinoma are described in whom spread of the tumor to mediastinal lymph glands caused obstruction to the superior vena cava. Although necropsy studies have shown that hepatocellular carcinoma occasionally metastasizes to mediastinal lymph glands, presentation with the superior mediastinal syndrome has not hitherto been reported.