Long-term Survival after Resection of Nonsynchronous Skull and Rib Metastases from Hepatocellular Carcinoma

Abstract

A-73-year old man who was given a diagnosis of hepatocellular carcinoma (HCC) underwent posterior sectionectomy. He found a palpable mass on the left frontal part of the skull 18 months postoperatively. The tumor marker levels were within normal range. Bone scintigraphy found no bone metastatic lesion apart from the one in the left frontal area. A skull bone tumor was suspected, and tumor resection was performed. Skull metastasis from HCC was revealed by histopathological examination. A mass lesion, on the right 10th rib with osteolysis was revealed by chest computed tomography at 3 years and 8 months following the resection of HCC. The serum level of PIVKA-II was elevated. Rib metastasis from HCC was suspected from elevated AFP levels. The tumor was resected with a portion of the10th rib. Rib metastasis from HCC was shown by a histopathological study. The patient is currently well, 5 years after the resection of HCC and 3 years and 7 months after the last metastasectomy without recurrence. Concerning bone metastases, strict observation during the postoperative course is essential for early detection and treatment.