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Vol. 57. Issue 5.
Pages 370 (May 2021)
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Vol. 57. Issue 5.
Pages 370 (May 2021)
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Hepatocellular Carcinoma With Pleural Metastases Without Residual Liver Tumor Diagnosed by Pleuroscopy
Carcinoma hepatocelular con metástasis pleurales y sin tumor hepático residual diagnosticado mediante pleuroscopía
Chia-Chi Kuoa, Chung-Yu Chenb,c,
Corresponding author

Corresponding author.
, Chien-Hung Chena,c
a Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
b Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
c Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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A 80-year-old man had history of hepatocellular carcinoma (HCC) status post right lobectomy of the liver; and prostate cancer, status post hormone therapy and radiotherapy. Elevation of alpha-fetoprotein (AFP) to 51.13ng/mL was noted during follow-up. The abdominal computed tomography (CT) yielded no local tumor recurrence over the liver (Fig. 1A). Unexpectedly discovery of right pleural effusion with a lot of pleural masses was found (Fig. 1B). The supplemental tumor markers of his prostate specific antigen (PSA) level was 0.661ng/mL (within normal range). Repeated thoracentesis for pleural effusion cytology and cell-block yielded negative for malignancy cell. Then, we performed a pleuroscopy, and a lot of cobble-like and protruding pleural masses are found (Fig. 2A). Peural masses of different sizes are revealed (Fig. 2B). Biopsy was performed and the pathology report showed carcinoma with hepatic origin (positive for arginase-1, hepar-1 and negative for calretinin).

Fig. 1.

A and B: In A abdominal computed tomography showing no local recurrence over the liver, and in B chest computed tomography showing multiple right pleural masses with moderate pleural effusion.

Fig. 2.

A and B: In A and B pleuroscopy shows multiple cobble-like and protruding pleural masses of different sizes.


The most common extrahepatic metastatic sites of HCC are lung, abdominal lymph nodes, adrenal gland and bones1. The pleural metastasis of HCC is rare. Most case with pleural metastasis also combined with direct liver tumor invasion to chest wall with hemothorax2,3. We report a case of pleural metastasis of HCC without direct invasion nor residual liver tumor. Our case was finally diagnosed by pleuroscopy biopsy.

S. Katyal, J. Oliver, M. Peterson, J. Ferris, B. Carr, R. Baron.
Extrahepatic metastases of hepatocellular carcinoma.
N. Sohara, H. Takagi, T. Yamada, T. Abe, M. Mori.
Hepatocellular carcinoma complicated by hemothorax.
J Gastroenterol, 35 (2000), pp. 240-244
C.-W. Yen, L.-S. Hsu, C.-W. Chen, W-H. Lin.
Hepatocellular carcinoma with thoracic metastases presenting as hemothorax: a case report and literature review.
Medicine (Baltimore), 97 (2018), pp. 22
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