Rare Site Hepatocellular Carcinoma Metastasis

Area of Science:

• Oncology
• Pathology

Background:

• Hepatocellular carcinoma (HCC) commonly metastasizes to the lung and peritoneum.
• Rare site HCC metastases (RSHM) can occur in unusual locations.
• This report details a novel case of HCC metastasis to the nail-bed.

Observation:

• A 66-year-old woman with a history of resected HCC presented with a painful, rapidly evolving nail-bed mass.
• The patient had prior metastases to the lung, spleen, and brain, treated with various therapies.
• Biopsy confirmed the nail-bed mass as HCC metastasis, leading to finger amputation.

Findings:

• Nail-bed metastasis represents a rare site for hepatocellular carcinoma.
• Elevated protein induced by vitamin K absence-II (PIVKA II) is associated with RSHM.
• The Lee nomogram aids in identifying patients at high risk for RSHM.

Implications:

• RSHM may indicate advanced HCC stage and portend a poor prognosis.
• Systemic treatment should be emphasized for patients with RSHM.
• Further research into risk factors and management of RSHM is warranted.