Hepatocellular carcinoma presenting as musculoskeletal metastases: A report of two cases

Extrahepatic metastases of hepatocellular carcinoma (HCC) occurs in approximately 37% of patients [1]. Common sites of hematogenous metestatic spread include the lungs, intra-abdominal organs, bones, and rarely skeletal muscle. Together, metastatic disease to the bones and muscle account for approximately 16% of all extrahepatic HCC metastases and are found primarily with advanced disease [1] and [10]. Metastatic symptoms are common in diagnosed HCC patients, but presentation of unkown HCC with metastatic symptoms is an uncommon finding. We report two cases of undiagnosed HCC presenting with symptoms related to metastatic lesions of the sacrum in one patient, and the gluteus muscles in another.