Can hepatocellular carcinoma (HCC) produce unconventional metastases? Four cases of extrahepatic HCC.

AIMS AND BACKGROUND Extrahepatic spread of hepatocellular carcinoma (HCC) diagnosed during the clinical course of the disease is not frequent; however, with the prolonged survival of HCC patients, the incidence of extrahepatic metastases seems to be increasing. METHODS AND STUDY DESIGN We present four unusual cases of extrahepatic metastasis from HCC: the first concerns a patient who underwent a liver transplantation for HCC with cirrhosis and three years later developed metastases in the lung and the left orbit; the second is that of a patient who developed an extraperitoneal pararectal metastasis; in the third case a large osteolytic lesion developed on the left iliac bone, and in the fourth case we found an isolated metastasis in the left mandible. RESULTS AND CONCLUSIONS These cases offer important information related to the unusual biology of isolated metastases from HCC after successful treatment of the primary cancer.