A CASE OF WELL-DIFFERENTIATED MINUTE HEPATOCELLULAR-CARCINOMA WITH EXTRAHEPATIC METASTASIS

A rare case of well-differentiated minute hepatocellular carcinoma (HC C) metastasizing to distant sites in a 77-year-old man with hepatitis C virus (HCV)-related cirrhosis is presented. Ultrasonography (US) dis closed a 9 mm hypoechoic lesion in segment seven (S-7) Of the liver, a lthough computed tomography (CT), magnetic resonance imaging (MRI) and angiography did not reveal any space-occupying lesion. Ultrasound-gui ded biopsy showed the histological features of well-differentiated HCC . A plain film of the abdomen and CT revealed osteolytic changes in th e sacrum and the lumbar vertebra. Ultrasound-guided biopsy of the sacr um revealed well-to-moderately differentiated HCC metastasizing from t he liver. Percutaneous ethanol injection therapy (PEIT) effected compl ete response and completely eliminated the abnormal findings on US. Th ree months after PEIT, metastasis to the thoracic vertebra was reveale d by CT, despite negative alpha-fetoprotein-mRNA in serum. This is the first report describing a well-differentiated HCC with metastatic pot ential. Further studies may provide insights into metastasis of well-d ifferentiated HCC.