HEPATOCELLULAR CARCINOMA PRESENTING WITH CANNONBALL PULMONARY METASTASES

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Cannonball pulmonary metastases are usually large, well-circumscribed, round lesions. They classically occur due to hematogenous dissemination of secondary malignancies to the lungs, including renal cell carcinoma, choriocarcinoma, prostate carcinoma, synovial carcinoma and endometrial carcinoma. Hepatocellular carcinoma presenting with cannonball pulmonary metastases is a rare phenomenon. CASE PRESENTATION: A 49-year-old Korean male with no significant known past medical history presented with a 4-week history of persistent back pain, weight loss, and progressive dyspnea with associated cough and hemoptysis. Physical examination was notable for tachycardia, tachypnea, hypoxia while breathing ambient air requiring supplemental oxygen, cachexia, and globally decreased breath sounds throughout all lung fields. Initial chest radiograph was notable for innumerable pulmonary nodules. Computed tomography of the chest was notable for over 100 cannonball pulmonary metastases. Additional imaging studies revealed brain, skeletal, liver and gastrointestinal lesions concerning for widely metastatic disease of unknown primary. Work-up revealed newly diagnosed (and thus, untreated) chronic, active hepatitis B infection with HBV DNA-PCR of 15,300 IntUnit/mL and an alpha fetoprotein level > 200,000 ng/mL. Biopsy of a skeletal lesion was consistent with metastatic hepatocellular carcinoma (HCC). Given the extent of the patient’s metastatic disease burden, poor performance status and advanced cirrhosis, he was transitioned to comfort care and patient expired 8 days after initial presentation. DISCUSSION: Hepatocellular carcinoma is a common malignancy in patients with chronic viral hepatitis B and C. Extrahepatic spread of HCC to the lungs is common with pulmonary metastases present on necropsy in up to 52% of patients. Metastatic HCC presenting with cannonball pulmonary metastases, however, is rare, with less than 5 cases reported in the medical literature. CONCLUSIONS: Prognosis for these patients is poor, although systemic therapy can be offered to those who retain an adequate performance status and liver function (Child-Turcotte-Pugh A or B cirrhosis). Reference #1: Honeyboune D. Lung metastases from a primary hepatocellular carcinoma. Thorax. 1980 Apr;35(4):316-17. DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Please note: $5001 - $20000 Added 03/17/2019 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Alice Chen, source=Web Response No relevant relationships by Lucas Cusumano, source=Web Response No relevant relationships by Iheanacho Emeruwa, source=Web Response