The Chest Wall Tumor as a Rare Clinical Presentation of Hepatocellular Carcinoma Metastasis.

BACKGROUND: Extrahepatic metastatic spread of hepatocellular carcinoma is present at the time of diagnosis in 5-15% of hepatocellular carcinoma patients. The most common site of metastastic spread is the lungs, bones, lymph nodes. Isolated chest wall localization is extremely rare.

CASE: We report a 58-year-old patient with large, synchronous chest wall hepatocellular carcinoma metastasis with solitary primary hepatocellular carcinoma. He underwent a radical, surgical en bloc metastasectomy and subsequent anatomic liver resection. Removal of this metastasis further led to aggressive dissemination to different sites during the course of the disease and subsequently the patient was treated with antiangiogenic therapy and, after failure, with systemic chemotherapy. Combined multimodality treatment in this case led to overall survival of 22-months. We suggest that the initial huge presentation of chest wall metastasis and consecutive aggressive dissemination after surgical removal could be explained by the biological process called "tumor self-seeding" by circulating tumor cells.

CONCLUSION: The chest wall hepatocellular carcinoma metastasis is a rare entity associated with poor prognosis. Radical surgical approach is limited to a minority of patients and may be justified for the treatment of extrahepatic metastases on a case by case basis.Key words: hepatocellular carcinoma - chest wall metastasis - metastasectomy - ciculating tumor cells.