Medical Image of the Week: Hepatocellular Carcinoma with Pulmonary Metastasis

A 58-year-old man with a history of hepatitis-C, liver cirrhosis and hepatocellular carcinoma treated with sorafenib and chemoembolization was admitted with septic shock due to spontaneous bacterial peritonitis with concomitant hemorrhage and acute renal failure.  The patient did not respond to broad-spectrum antibiotics, aggressive care with multiple vasopressors and ventilatory support and died shortly after admission.  An autopsy was performed revealing hepatocellular carcinoma with extensive intra-abdominal and thoracic metastasis.

Figure 1. Axial CT image of upper abdomen revealing cirrhotic liver with a large mass in left hepatic lobe (star) and massive ascites.

Figure 2. Cross-section of liver showing green-yellow hepatocellular carcinoma in left hepatic lobe (star).

Figure 3. Cross-section of lung showing numerous green-yellow metastatic lesions in pulmonary parenchyma and hilar nodes.

Figure 4.  Hematoxylin and eosin (40x [Panel A] and 100x [Panel B]) stained lung demonstrating micro-tumor emboli (arrows) of hepatocellular carcinoma.

Tauseef Afaq Siddiqi MD¹, Sachin Chaudhary MD¹,Nicholas Hernandez MD², Christopher Geffre MD² and Richard Sobonya MD²

¹ Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona, Tucson, AZ 85724, United States

² Department of Pathology, The University of Arizona, Tucson, AZ 85724, United States.

Reference as: Siddiqi TA, Chaudhary S, Hernandez N, Geffre C and Sobonya R. Medical image of the week: hepatocellular carcinoma with pulmonary metastasis. Southwest J Pulm Crit Care. 2013;6(5):234-6. PDF