HCA Healthcare / USF Morsani College of Medicine, Brandon Regional riverview, FL, United States
Daniel A. Casas, DO1, Tilisha Persaud, MD1, Chukwuyem Obia, MD2, Joshua Bullington, DO3, Deepa Budh, MD4, Sohaib Hassan, MD3, Bhavtosh Dedania, MD5 1HCA Healthcare / USF Morsani College of Medicine, Brandon Regional, Riverview, FL; 2HCA Healthcare, USF Morsani College of Medicine, Brandon Regional Hospital, Riverview, FL; 3HCA Healthcare / USF Morsani College of Medicine GME, Brandon Regional, Brandon, FL; 4SBH Health System, Bronx, NY; 5Florida Digestive Health Specialists, Brandon, FL
Introduction: Hepatocellular Carcinoma (HCC) is the most common primary liver cancer. While HCC typically arises in cirrhosis, approximately 20% manifest in the non-cirrhotic liver (NCL). Extrahepatic metastasis is seen in 64% of patients, but less than 1% of cases metastasize solely to the spleen. Here we present a case of HCC with isolated splenic metastasis in a non-cirrhotic patient with no risk factors
Case Description/Methods: An 84-year-old Caucasian male with a history of Barrett’s esophagus and remote history of prostate cancer s/p prostatectomy presented with worsening dyspnea and vague abdominal pain. He denied heavy alcohol use, illicit drugs, family history of hepatitis or chronic liver disease. On physical exam, his abdomen was distended with palpable hepatosplenomegaly and diffuse tenderness to palpation. Labs were notable for AST109 IU/L, ALT46 IU/L, ALP122 IU/L, and INR of 1.1. Further workup, including hepatitis panel, ANA, ASMA, AMA, and a colonoscopy 6 months ago, were all negative. A subsequent dedicated CT revealed multiple liver masses, the largest measuring 8.4 cm in the left lobe of the liver. Further, a splenic mass measuring 13 x 11 x 16 cm was identified (Fig 1). Tumor markers were mildly elevated AFP 9.6 ng/mL and CA 19-9 and PSA was WNL. Due to concerns for metastasis, a percutaneous US-guided liver biopsy was performed, revealing a poorly differentiated hepatocellular carcinoma with no evidence of cirrhosis. CT of the chest and MRI of the brain were obtained for staging purposes without further evidence of metastasis. Upon discharge, the patient returned to his home state for palliative chemotherapy
Discussion: HCC in NCL is a known but infrequent event. Our patient did not have any pathological evidence of cirrhosis. Adding to the challenge of identifying the primary malignancy, our patient presented with a large splenic mass with similar characteristics on imaging to the hepatic mass; no other extrahepatic metastasis was identified.
Splenic metastasis is uncommon, and invasion is seen in disseminated malignancies involving multiple organs. The incidence is approximately 0.7-0.8% in disseminated cases. To our knowledge, there are less than 10 cases reported of solitary splenic metastasis from HCC.
HCC in the NCL is a complex disease that poses a challenge for surveillance. At this time, there is limited data available, and further studies are needed to open new avenues for novel screening strategies for early detection and thusly improve disease burden and prognosis
Figure: Figure 1: CT abdomen with contrast: (a) axial view; red arrow indicates splenic mass; white arrow indicates hepatic masses; (b) coronal view (Note: not all hepatic masses are shown in this image)
Daniel Casas indicated no relevant financial relationships.
Tilisha Persaud indicated no relevant financial relationships.
Chukwuyem Obia indicated no relevant financial relationships.
Joshua Bullington indicated no relevant financial relationships.
Deepa Budh indicated no relevant financial relationships.
Sohaib Hassan indicated no relevant financial relationships.
Bhavtosh Dedania indicated no relevant financial relationships.
Daniel A. Casas, DO1, Tilisha Persaud, MD1, Chukwuyem Obia, MD2, Joshua Bullington, DO3, Deepa Budh, MD4, Sohaib Hassan, MD3, Bhavtosh Dedania, MD5. P1918 - Isolated Splenic Metastasis From Hepatocellular Carcinoma on an Octogenarian With Non-Cirrhotic Liver, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.