Recurrent Aggressive Hepatocellular Carcinoma Presenting With Chest Wall Metastasis and Portal Vein Thrombosis: A Rare Case and a Multidisciplinary Perspective

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, often presenting with aggressive intrahepatic and extrahepatic spread. Extrahepatic metastasis occurs in a significant proportion of advanced HCC cases, most commonly affecting the lungs, regional lymph nodes, bones, and adrenal glands. However, metastasis to the chest wall is exceedingly rare and infrequently reported in the literature. We report an unusual case of a 71-year-old male with chronic hepatitis C infection and a history of HCC resection in 2019, who presented with abdominal distension, lower extremity edema, and a rapidly enlarging chest wall mass. Imaging and biopsy confirmed metastatic HCC, showing trabecular architecture and positive immunohistochemical staining for HepPar-1 and glypican-3, with portal vein thrombosis (PVT) and chest wall involvement - a rare metastatic pattern. This case highlights HCC's aggressive nature, the importance of early recognition of atypical metastases, and the value of multidisciplinary management - encompassing oncology, hepatology, radiology, and pathology - in improving patient outcomes.

Keywords: chest wall metastasis; hepatitis c; hepatocellular carcinoma (hcc); portal vein tumor thrombosis; recurrence.

Figure 1. CT images showing hepatic metastasis and tumor-associated right portal vein thrombosis.

CT, computed tomography

Figure 2. CT images demonstrating chest wall metastasis of HCC with rib involvement and left pleural effusion.

CT, computed tomography; HCC, hepatocellular carcinoma