Hepatocellular Carcinoma Case Summary

A RARE CASE: AN ADVANCED STAGE HEPATOCELLULAR CARCİNOMA PATİENT PRESENTED WİTH MULTİPLE SPLENİC METASTASES

SUMMARY:

Hepatocellular carcinoma is the most common primary liver tumor and it is one of the most common cause of deaths in patients with cirhosis. İt’s histopathologic diagnosis is difficult because biopsy usually couldn’t perform due to risc of bleeding. Clinicians especially diagnose it with radiologic and clinical parameters of patient. Splenic metastases are rarely conditions. But when its present we should make an examination for finding primary tumor. We aimed in this case report when a splenic metastasis occur, we should think hepatocellular carcinoma as a primary tumor.

Key words: hepatocellular carcinoma, splenic metastasis,

Other physical examination findings were normal. The patient had no known chronic illnes. But he had history of taking alcohol 20-40 gr / daily and smoking 1-2 pockets / daily for 40 years. He had no special family history. Patient’s laboratory findings were ; creatinin: 1.02 mg/dl, albumin: 2.9 mg/dl, Total bilurubin: 4.0 mg/dl, ALT:22 IU/L AST:20 IU/L, hemoglobin:10.6 gr/dl, platelet: 232.000, protrombin time: 18.7 sn, INR: 1.37, serum protein elektrophoresis: beta-gamma bridging, serum-ascites albumin gradient: 2.1 gr/dl, AFP: 6000 IU/ml, CA 19.9-CA 125-CEA: negatif, HBsAg (+), HBeAg (-), HBV DNA: 61.700 IU/ml, HDV (-), AntiHCV (-), markers for otoimmun hepatites and other etiological tests were negative. The patient was diagnosed as chronic dekompansated liver parenchymal disease due to ethanol taking and chronic heatitis B (HBV) infection. His Child-Pugh score was 9.0 (B) and MELD score was 15. He had not hepatic encephalophaty and spontaneous bacterial peritonitis infection. Stage 2 oesophageal varices were present at his gastroscopic study. We gave lamivudin 100 mg po / day for his chronic HBV infection, propronalol 40 mg po bid / day as primary prophylaxis for his varices, furosemid 40 mg po / day and

First of them is hematogenious spreading and the other one is directly planting which is more commonly seen at genitourinary tumors(3). According to 25 yeared clinicopathological study of Lam KY et al; most common primary tumors metastas to spleen: breast (22.9%), lung (20.2%), colon and rectum (9.4%), ovary (9%), stomach (6.9%) and skin (esp. malignant melanoma-5%). According to same study metastasis from liver cancers are 2.8%(16). İn our case malignancies can metastate to spleen were excluded.

60% of splenic metastases have no clinical symptom. Most of them are found insidentaly at examinations. Fatigue, weight loss, fever, abdominal pain, splenomegaly, anemia and trombositopenia are rarely seen symptoms and signs. Most rare finding is splenic rupture(18-19). Also in our case no spesific symptom or sign was present.

İn this case report; an advance stage HCC patient which has no spesific symptom, incidentally detected and has rarely seen multiple splenic metastases was summarized. İn our country a case report including 2 cases about this subject is present(8).

İn conclusion; it shouldnt be forgotten that HCC can metastate to spleen even it is rarely seen and HCC should be considered when the splenic metastases were