Chest wall metastasis - hepatocellular carcinoma

Case contributed by Mohit Godar
Diagnosis certain

Presentation

Rapidly growing chest wall mass.

Patient Data

Age: 60 years
Gender: Male

Mildly enhancing heterogeneous soft tissue mass in the left posterolateral chest wall, grossly measuring 85x95x77 mm. The mass invades and destroys the 8th rib, mildly erodes the cortex of the 7th and 9th ribs.  Inferiorly, it abuts the left hemidiaphragm, while posteriorly, it abuts the left serratus anterior and latissimus dorsi muscles without invasion.  The left lower lung is indented by the mass with areas of subsegmental atelectasis.

Background cirrhosis with decreased attenuation (fatty liver).  Confluent irregular, arterial enhancing masses involving segment 2/3, segment 4 and segment 7/8, the largest measures 30x60 mm with invasion of segmental (2/3 and 7/8) portal vein branches. The lesions remain hyperattenuating to the fatty liver parenchyma. 6-mm calcified focus in hepatic segment 8.

Diffuse lumbar spondylosis with bridging osteophytes in L1 to L5 with decreased disc height. Minimal bilateral gynecomastia.

Enhancing nodule in the lateral limb of right adrenal gland abutting the hepatic segment 6.

Rest of the visualized thoracic and abdominal structures are normal.

Attenuation values of the liver and chest wall masses.

Case Discussion

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. The lung and bone are the two most common sites for the metastasis of HCC. Our patient presented with rapidly growing chest wall mass that was subsequently biopsied and revealed metastatic HCC.

Typical HCC features of arterial phase enhancement with washout on portal venous phase relative to liver parenchyma apply to cirrhotic liver. In this case, decreased attenuation due to generalized hepatic steatosis means that washout cannot be assessed on CT.

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