A cervical spine metastasis of a hepatocellular carcinoma: a rare presentation

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality globally, with bone metastases signifying advanced disease and a poor prognosis. Although bone metastases in HCC are relatively uncommon, they present significant diagnostic and therapeutic challenges. We present a rare case of cervical spine metastasis as a presenting feature of HCC progression, highlighting the need for timely diagnosis and multidisciplinary care.

Case presentation: A 55-year-old North African female with a history of hepatitis C-related cirrhosis, successfully treated with antiviral therapy, was diagnosed with HCC following the detection of hepatic nodules during routine biannual surveillance. After unsuccessful radiofrequency ablation (RFA), she developed intense cervical pain. Imaging revealed osteolytic cervical lesions and a paravertebral mass. Biopsy confirmed metastatic HCC. She received radiotherapy and immunotherapy (atezolizumab-bevacizumab). Despite treatment, her condition deteriorated due to cranial bone metastases, leading to intracranial hypertension and death.

Conclusions: Cervical spine metastasis in HCC is rare and carries a poor prognosis. Early clinical suspicion, advanced imaging, and timely intervention are crucial. Limitations in current treatments emphasize the need for improved therapeutic strategies. A deeper understanding of the molecular mechanisms and oncogenes involved in HCC bone metastases can reveal potential therapeutic pathways for treatment.

Keywords: Hepatocellular carcinoma; bone metastasis; case report; cirrhosis; immunotherapy; radiotherapy.

Figure 1.

Hepatic MRI showing two hepatic nodules between segments V and VI classified as LI-RADS V and LI-RADS IV.

Figure 2.

Cervical spine MRI revealing a lytic lesion of the spine, centered on C1 and C2 with a soft-tissue mass in the left paravertebral space.

Figure 3.

Bone scintigraphy showing hyperfixation at the level of the posterior arch of the 9th rib, the L3 vertebral body, the trochanteric region of the right femur, and the right temporal bone suggestive of secondary nature.

Figure 4.

(a) Hepatoid tumor proliferation(H&Ex40). (b) Tumor proliferation with a macrotrabecular and solid growth pattern (H&Ex100). (c) The tumor cells are large, featuring eosinophilic cytoplasm and irregular, hyperchromatic nuclei containing nucleoli (H&Ex400).