Calcaneal localization of extrahepatic hepatocellular carcinoma presented with chronic hindfoot pain

Lastella G., Avola E., Esposito A.

Hepatocellular carcinoma (HCC) metastasizes mainly in the liver through portal vein, only few patients report metastases in distant organs and bone is considered a rare site of HCC metastases. We report the case of a man with HCC, who presented with chronic right hindfoot pain, in which bone scintigraphy and computed tomography (CT) revealed a rare secondary calcaneus localization.

Case description. A 58-year-old man with multi-treated HCC, during a hepatological follow-up, complained of chronic right hindfoot pain, unresponsive to analgesic therapy. The bone scintigraphy shows focal hypercaptations in the right calcaneus and, less evidently, in the right tibia. CT showed multiple focal solid enhancing nodules in the tibial bone marrow, and a 3,5-cm solid enhancing nodule in the calcaneal body, with cortical interruption and invasion of adjacent soft tissues. HCC calcaneal metastasis was confirmed through a biopsy.

Conclusion. In a patient with HCC and chronic hindfoot pain, with increase of alpha-fetoprotein levels, the possibility of a distant metastasis should be taken in account, as in our case, even though it is a rare cause.

 

1 - Università degli Studi di Milano.

2 - Foundation IRCCS Ca’ Granda Maggiore Policlinico Hospital, Radiology Department. Milan, Italy

 

Keywords: kidney calculi; hematoma; Wunderlich syndrome.

 


Corresponding author:  Ernesto Roldan-Valadez e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Salazar-Ruiz S.Y, Nino-Najera W., Roldan-Valadez E. Wunderlich syndrome (spontaneous subcapsular renal haemorrhage) associated with renal abscess: CT imaging of pre-renal and post-renal drainage. REJR 2021; 11(2):233-237. DOI: 10.21569/2222-7415-2021-11-2-233-237.

Received:       09.05.21 Accepted: 25.06.21