Bilateral breast lesions mimicking metastases of hepatocellular carcinoma in a male patient

Abstract

Hepatocellular carcinoma metastases to the breast have been reported only rarely.
A 63-year-old male patient with metastatic hepatocellular carcinoma presented with a lump in his left breast. On physical examination, there was a hard, well-circumscribed, and partially mobile mass of 2 cm in diameter in the lower
middle quadrant of the left breast. Breast ultrasound revealed a hypoechoic solid lesion of 1.8 cm × 1.9 cm in diameter in the lower middle quadrant of the left breast. F-18 FDG PET/CT imaging revealed bilateral subcutaneous
nodular lesions of anterior chest wall that were adjacent but not invasive to the glandular tissues of the breasts, with
high SUVmax values. Tru-cut biopsy result of the mass in the left breast region was reported as hepatocellular carcinoma metastasis. Positive immunohistochemical staining for Hep Par 1 and glypican-3 were detected. While the patient
was on sorafenib therapy, he died 6 months later.
Hepatocellular carcinoma is a common malignancy for which chronic hepatitis B infection has been defined as the most
common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain, respectively, and
metastases to the breast have been reported extremely rarely. Breast metastasis from non-mammary malignant neoplasm
is rare, accounting for approximately 2% of breast tumors. Metastasis to the breast from an extramam mary neoplasm
usually indicates disseminated metastatic disease and a poor prognosis.
It should be borne in mind that a mass lesion detected in the breast region by physical examination and imaging
methods may be a hepatocellular carcinoma metastasis in male or female patients with hepatocellular carcinoma.