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Case Reports
. 2025 Jul 5;17(7):e87330.
doi: 10.7759/cureus.87330. eCollection 2025 Jul.

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

Nasim Salimiaghdam  1 , Ahmed Mustafa  2 , Irene O Pokuaa  2 , Afshin Hamidi  2 , Emily Chen  3
Affiliations
Case Reports

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

Nasim Salimiaghdam et al. Cureus. .

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.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT images showing hepatic metastasis and tumor-associated right portal vein thrombosis.
CT, computed tomography
Figure 2
Figure 2. CT images demonstrating chest wall metastasis of HCC with rib involvement and left pleural effusion.
CT, computed tomography; HCC, hepatocellular carcinoma
See this image and copyright information in PMC

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