Metastatic Pattern of Spread of Hepatocellular Carcinoma
Introduction:
HCC occurs mostly in cirrhotic patients, although it can arise in patients with chronic hepatitis as well. HCC is often unresectable because of multifocality, vascular invasion or size, but metastatic disease can occur as well, especially in larger tumors.
Prevalence: Uncommon Metastasis Frequency: Uncommon
References:
AJR Am J Roentgenol. 2011 Oct;197(4):W658-64. PMID: 21940537
Surgery. 2007 Feb;141(2):196-202. PMID: 17263976
Primary Tumor:
| Characteristics | Comments | |
| Liver | Wash-Out, Arterially Enhancing | HCC lesions are arterially enhancing (versus normal liver or regenerating nodules, which enhance with the portal venous phase). The display wash-out, i.e. decreased enhancement compared to liver on PV phase. |
Known Metastatic Locations:
| Site | Frequency | Characteristics | Comments |
| Portal Vein | Common | Tumor Thrombus | tumor or bland thrombus |
| Liver | Common | Wash-Out, Arterially Enhancing | |
| Lung Parenchyma | Common | Nodule | most common distant site |
| Bone | Common | Lytic | |
| Local Lymph Nodes | Common | regional lymph nodes - perihepatic, peripancreatic, and retroperitoneal - found in 30-40% of cases |
|
| Brain | Uncommon | ||
| Adrenal Glands | Uncommon | ||
| Inferior Vena Cava | Uncommon | Tumor Thrombus | invades hepatic veins and spreads proximal to IVC |
| Distant Lymph Nodes | Rare | ||
| Bladder | Very Rare | ||
| Kidney | Very Rare | ||
| Ovary | Very Rare | ||
| Skin (Cutaneous and Subcutaneous) | Very Rare | ||
| Peritoneum | Very Rare |