Hepatocellular Carcinoma: First Manifestation as SolitaryHumeral Bone Metastasis

Hepatocellular carcinoma (HCC) most commonly presents with abdominal pain or mass, fever of unknown etiology, weight loss,and decompensation of known liver disease or at an asymptomatic stage through surveillance. Rarely, presenting symptoms can beexclusively related to extrahepatic metastases. Herein, we write a case of a patient with no known liver disease, presenting with apathological fracture of the proximal humerus bone secondary to a massive solitary metastasis from HCC. This case representsan unusual appendicular skeletal metastasis in a patient with unknown primary HCC, successfully treated with sorafenib. Theprognosis of HCC patients with extrahepatic metastasis is poor, and in the presence of bone metastases, the mean survival rateis severely reduced. However, the multikinase inhibitor sorafenib has been the standard of treatment. Recently, there has beendevelopments of other therapeutic class of drugs (i.e., immune check inhibitors), which have shown promising benefits andbetter side effect profiles. Still, there is a need for further studies, owing to challenges in recognizing cellular and molecular markers.