A case of hepatocellular carcinoma followed by asynchronous metastasis to the lung and thoracic spine following radical ablation treatment

Abstract

An 87-year-old man was referred to our hospital with hepatocellular carcinoma (HCC) of 20 mm in diameter in segment 5 of the liver. Subsequently, radical treatment by radiofrequency ablation (RFA) was successfully conducted. Six months after RFA, he received direct acting antiviral treatment and achieved eradication of the hepatitis C virus (HCV). Two years following HCV eradication, a solitary abnormal nodule in his right lung was detected, accompanied by an increase in his serum des-gamma-carboxy prothrombin level. Subsequent partial lung resection was successfully performed, and the resected specimen revealed a metastasis of the HCC. Three years after lung metastasectomy, a metastatic focus at the T6 vertebra was detected. Radiation therapy, followed by systemic chemotherapy of lenvatinib, an oral multi-kinase inhibitor, was conducted. Recently, we encountered this HCC case exhibiting distant metastasis and lacking intrahepatic recurrent lesions. In such a case, treatment selection based on the treatment progress and condition is essential for the prognosis extension.