Spermatic Cord and Peritoneal Metastases from Unruptured Hepatocellular Carcinoma

Extrahepatic metastases are not uncommon in patients with late-stage hepatocellular carcinoma (HCC). These extrahepatic lesions are most commonly found in the lungs, lymph nodes and bones. The authors report the case of a patient with chronic liver disease who presented with left inguinal swelling which was thought to be incarcerated hernia on clinical examination. Further evaluation revealed that the patient had HCC with spermatic cord metastasis which was masquerading as inguinal hernia. He also had extensive peritoneal dissemination. Awareness and accurate detection of these unusual sites of extrahepatic dissemination of HCC is of paramount importance for radiologists to avoid unnecessary surgery as well as after loco regional therapy to assess for recurrence. Details of the case are discussed with a review of the relevant literature.