Metastasis of hepatocellular carcinoma to the lungs and Virchow node or metachronous/synchronous tumors? A case report

Abstract

Introduction: Hepatocellular carcinoma (HCC) presenting with another primary cancer is rarely documented, and when occurring in the setting of HCC metastasis to the left supraclavicular lymph node (Virchow node), documentation is even rarer. The purpose of this article is to report such an occurrence. Here we describe evidence supporting the presence of two distinct primary tumors from the liver and lung of a 44-year-old female cadaver, consistent with synchronous or metachronous tumors. Case presentation: The reported cause of death in a 44-year-old female cadaver was hepatocellular carcinoma of the liver with metastasis to the lung and lymph nodes. However, complete investigation of the body with histologic sections revealed two distinct malignant tumor processes – one involving the lung with features compatible with a neuroendocrine carcinoma, and the other involving the liver and left supraclavicular lymph node with features compatible with hepatocellular carcinoma. Interestingly, both tumors showed multifocal involvement of the organs in which they were discovered. Conclusion: Given the discrepancy between the reported cause of death and cadaveric findings, this case highlights the importance of closely comparing the histologic features between tumors in order to allow for accurate diagnosis and treatment. In addition, the findings highlight the utility for thorough gross and histopathological examination of cadaveric specimens to inform not only medical students, researchers, and educators but also physicians in their approach to diagnosis.

Keywords

• Metachronous cancer
• Synchronous cancer
• Virchow node
• Hepatocellular carcinoma
• Cadaver
• Metastasis