BACKGROUND: Primary diagnosis of hepatocellular carcinoma (HCC) by a shoulder metastasis is a rare event. HISTORY AND CLINICAL FINDINGS: A 68-year-old man was admitted with swelling of his left shoulder. No further clinical symptoms. Alcohol consumption: 1 l beer/day. On ultrasound, the clinically impressing tumor of the left shoulder showed calcifications. INVESTIGATIONS: Histologic examination of the tumor of the shoulder showed a well-differentiated, trabecular carcinoma consistent with the metastasis of an HCC. Subsequent ultrasound of the abdomen gave evidence of liver cirrhosis. In addition, an infiltrating mass was found, which encompassed 75% of the right liver lobe and was subsequently shown by histology to be a well-differentiated HCC with identical features of the tumor of the shoulder. Further metastases with pathologic rib fractures were found on CT scan of the thorax. DIAGNOSIS: Based on clinical findings, laboratory investigations and imaging studies, the patient suffered from an HCC owing to ethyl-toxic liver cirrhosis stage Child C, and initially presented with a shoulder metastasis. THERAPY: Due to the advanced tumor stage, no curative or palliative therapy was administered. CONCLUSION: This is an interesting case of an atypical primary diagnosis of HCC. The most important information was given by the pathologists who raised the suspicion of a metastasizing HCC by examining the tumor of the shoulder.
BACKGROUND: Primary diagnosis of hepatocellular carcinoma (HCC) by a shoulder metastasis is a rare event. HISTORY AND CLINICAL FINDINGS: A 68-year-old man was admitted with swelling of his left shoulder. No further clinical symptoms. Alcohol consumption: 1 l beer/day. On ultrasound, the clinically impressing tumor of the left shoulder showed calcifications. INVESTIGATIONS: Histologic examination of the tumor of the shoulder showed a well-differentiated, trabecular carcinoma consistent with the metastasis of an HCC. Subsequent ultrasound of the abdomen gave evidence of liver cirrhosis. In addition, an infiltrating mass was found, which encompassed 75% of the right liver lobe and was subsequently shown by histology to be a well-differentiated HCC with identical features of the tumor of the shoulder. Further metastases with pathologic rib fractures were found on CT scan of the thorax. DIAGNOSIS: Based on clinical findings, laboratory investigations and imaging studies, the patient suffered from an HCC owing to ethyl-toxic liver cirrhosis stage Child C, and initially presented with a shoulder metastasis. THERAPY: Due to the advanced tumor stage, no curative or palliative therapy was administered. CONCLUSION: This is an interesting case of an atypical primary diagnosis of HCC. The most important information was given by the pathologists who raised the suspicion of a metastasizing HCC by examining the tumor of the shoulder.