[Unusual cause of sternal swelling]

We here report the case of a 64-year old woman followed up for cirrhosis due to hepatitis C virus who didn't respond favorably to antiviral treatment. During her last follow-up visit, she reported the occurrence of painful anterior chest hump. Physical examination showed hard immobile mass at the level of the manubriosternal joint. The patient underwent sternoclavicular CT scan, which objectified expansive osteolytic lesion centered upon the sternal manubrium invading the soft tissues (A, B). The biopsy revealed malignant papillary epithelial tumor expressing pancytokeratin and CK7. Patient's profile suggested the presence of a metastasis from cholangiocarcinoma or osteophilic tumor. Gynecological examination, associated with mammogram and breast ultrasound, excluded a gynecological origin. The diagnosis of thyroid tumor was excluded on ultrasound. Chest CT scan showed multiple secondary pulmonary nodules. Abdominal angioscanner revealed the presence of a tissutal hepatic mass measuring 6 cm invading the portal bifurcation with portal vein thrombosis, suggesting hepatocellular carcinoma (HCC) (C). Given the discrepancy between anatomopathological data and morphological data, immunohistochemical study of the anti-Hep-Par-1 was performed, showing antibody expression on tumor cells. The diagnosis of manubriosternal metastasis from poorly differentiated hepatocellular carcinoma was retained. The patient was recommended to undergo chemotherapy. Bone metastases revealing HCC are exceptional. However, HCC should be suspected in patients with lytic bone lesion, especially in patients with chronic liver disease. Given its poor prognosis, treatment is based on palliative therapy with the aim of improving mainly the quality of life of patients.