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Introduction: Acrometastasis occur : infrequently, accounting for approximately 0.1% of all metastatic osseous
involvement. Its presentation nrimics infectious or inflammatory disease. Primary presentation of HCC as bone
metastasis is rare. When present, they are mostly vertebral, rib or skull deposits. Primary manifestation of HCC as
acrometastasis is extremely rare.
Case Report: A 59 year old alcoholic male was admitted with sudden onset profuse bleeding from art ulcer
involving middle and proximal phalanx of left middle finger. This was a chronic wound following a road traffic
accident. Patient underwent amputation of this finger for the clinical diagnosis of chronic osteomyelitis. Macroscopy
of amputated finger showed a continuous lesion from skin to bone with evidence of bone destruction. Microscopy
together with immunohistochemistry (HepPa 1 antibody) confirmed a deposit of a HCC with skin and bone
infiltration. Follow up radiological investigations revealed two foci of hepatocellular carcinoma with background
cirrhosis.
Discussion: HCC show a haematogenous spread usually via pulmonary circulation and vertebral circulation. Hence
the mechanism of spread into bones other than the bones of the axial skeleton, bypassing the lung is not explained.
Amputation, radiation, excision, and systemic therapy are the available treatment options. Radiotherapy is an
effective and non-invasive treatment that improves patient’s quality of life. When patients present with lytic lesions
of the bone considering a deposit of a HCC despite the site will be helpful to complete tire preoperative work up
with a USS of abdomen. The presence of acrometastasis in patients with cancer helps staging the disease and usually
indicates a very poor prognosis.
