Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass.

Hepatocellular carcinoma (HCC) is a common cancer worldwide. Extrahepatic spread is not unusual during HCC disease, but bone metastases at initial presentation are rare. We describe a case of HCC presenting with a clavicular head mass and spinal metastases with normal α-fetoprotein (AFP) level and hepatitis C virus infection without cirrhosis. After undergoing bone and liver biopsies, the patient started a 12-week course of sofosbuvir/velpatasvir and bevacizumab/atezolizumab for lifelong therapy with palliative intent. Since 2021, the patient has been receiving a combination of bevacizumab and atezolizumab every 21 days. On this regimen as of March 2023, his osseous metastases were stable and his liver lesions had not enlarged. This case demonstrates a very unusual HCC presentation, the importance of a thorough workup of bone metastasis, and the limited value of AFP for HCC screening, even in disseminated disease.

Citation

Rohit Gupta, Joshua Hirsch, Maya Guhan, Jeffrey Triska, Ruben Hernaez, Addison Taylor. Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass. Oncology (Williston Park, N.Y.). 2023 Aug 08;37(8):335-338

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PMID: 37616520

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