Hepatocellular carcinoma (HCC), sixth most common cancer world-over, commonly metastasizes to lung, lymph nodes and adrenal glands. Incidence of osseous metastases in HCC has been reported to be 3-20 % which occurs predominantly in the axial skeleton. It only rarely occurs in the appendicular skeleton and that too as the solitary focus of metastatic deposit.3,4 We present a case of HCC with solitary osseous metastases to the proximal tibia.
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Bone lesions of the appendicular skeleton can be caused by primary benign or malignant tumors, metastases, osteomyelitis, or pseudotumors. Conventional radiography plays a crucial role in the initial assessment of osseous lesions and should not be underestimated even in this era of modern complex and advanced imaging technologies. Combined with patient age, clinical symptoms and biology, and lesion features including location, solitary versus multiplicity, density, margin (transitional zone evaluated with Lodwick-Madewell grading score), and, if present, the type of periosteal reaction and matrix mineralization can narrow the differential diagnosis or offer a likely diagnosis.
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Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal- 576104, Karnataka, India.
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