Hepatocellular carcinoma with initial presentation as metastatic spinal cord compression

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. The burden of HCC is highest in the sub-Saharan Africa, South-East Asia and China. The recognized risk factors for HCC are chronic hepatitis B virus and hepatitis C virus infection, dietary aflatoxin, and alcoholic liver disease among others. HCC typically presents with symptoms related to the primary tumor; abdominal pain, weight loss, and abdominal swelling. Extrahepatic spread is present in up to 15% of patients with HCC at the time of diagnosis and may be the primary presentation. The most common site of extrahepatic metastasis by several authors is the lungs. Bone metastases in HCC are not as rare as previously reported and the most frequent site is the spine. Bone metastasis is mainly osteolytic and may result in pathologic fractures, hypercalcemia, and reduced quality of life. Spinal metastasis of HCC is recognized as a terminal stage of the disease and considerably worsens the prognosis. Presented is a case of a 35-year old man who came to the hospital primarily with metastatic spinal cord compression syndrome with paraplegia and was found to have advanced HCC. He succumbed to the disease within one month of presentation. While Pott's disease of the spine and metastatic prostatic tumor are the most common causes of nontraumatic myelopathy in sub-Saharan Africa, HCC should always be considered in the differential diagnosis of any patient with vertebral disease of uncertain origin.