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Metastatic Pattern of Spread of Hepatocellular Carcinoma  adult

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

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:

SiteFrequencyCharacteristics Comments
Portal Vein CommonTumor Thrombus tumor or bland thrombus
Liver CommonWash-Out, Arterially Enhancing
Lung Parenchyma CommonNodule most common distant site
Bone CommonLytic
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 UncommonTumor 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