B0583 - A Pain in the Neck: A Rare Site for Hepatocellular Carcinoma

Esteban Grovas-Cordovi, MD¹, Zeyn Mirza, MD¹, Carla Blanco, MD¹, Alejandro Martino, MD¹, Kathia E. Rosado-Orozco, MD², Jose Martin Ortiz, MD, FACG^1
1VA Caribbean Health Care System, San Juan, Puerto Rico; ²VAMC Caribbean, San Juan, Puerto Rico

Introduction: Hepatocellular carcinoma (HCC) with metastasis to thyroid is very rare with few cases reported in the literature. The clinical presentation of HCC ranges from asymptomatic to hepatic encephalopathy, ascites, palpable mass in the upper abdomen, with paraneoplastic syndromes or with extrahepatic metastasis. Thyroid metastasis is uncommon as the initial presentation of HCC.

Case Description/Methods: Case of a 62 year-old man with history of compensated liver cirrhosis, likely due to alcohol. Patient was a retired worker from heavy metal processing industry. He complained of worsening right shoulder pain for several months and a growing left neck mass. Imaging studies were done and shoulder radiograph revealed the presence of a large lytic lesion at the proximal humerus. Thyroid ultrasound and neck computed tomography revealed a large complex heterogeneous hyper vascular nodularity projecting at the left aspect of the neck, concerning for malignancy. A neck biopsy was performed as thyroid malignancy was suspected. The morphology (polygonal cells in a vaguely trabecular pattern) in combination with arginase1 positivity and lack of CK7 and CK20 was more consistent with HCC. Due to the rarity of the case, bone lesion was biopsied and showed same result as the neck lesion. Further studies revealed extensive metastatic disease and presence of several liver lesions, markedly elevated Alpha-Feto protein above 60 000.00ng/dL, thyroglobulin at 6.2 and Antithryroglobuin antibody at < 1 all in favor of HCC. Patient was started on Bevacizumab with Atezolizumab and radiotherapy for bone lesions.

Discussion: HCC is the most common primary tumor of the liver, mostly affecting patients that are diagnosed with cirrhosis, it constitutes the fifth most common cause of cancer in the world. The most common sites for HCC metastasis are the lungs, abdominal lymph nodes, adrenal glands, or bones, making distant lymph node metastases rare. Given the rarity of this case and atypical presentation of HCC, the diagnosis was delayed since the patient never developed the usual symptoms of cirrhosis despite his advanced disease stage. This case stresses the importance that there should be a low index of suspicion in patients with known risk factors for HCC and that special attention should be given to the clinical history despite such an unusual presentation and atypical disease course.



Disclosures:


Esteban Grovas-Cordovi, MD¹, Zeyn Mirza, MD¹, Carla Blanco, MD¹, Alejandro Martino, MD¹, Kathia E. Rosado-Orozco, MD², Jose Martin Ortiz, MD, FACG¹. B0583 - A Pain in the Neck: A Rare Site for Hepatocellular Carcinoma, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.