Evaluation of bone metastasis as the first presentation of hepatocellular carcinoma using 18-fluorodeoxyglucose positron emission tomography-computed tomography
A 75-year-old man presented with left thoracolumbar pain that he had for 3 weeks to internal medicine out-patient department in Ataturk University School of Medicine, Erzurum at Turkey. He had no history of previous injury. The patient did not have clinical symptoms of systemic diseases, such as malaise, weight loss or fever. Physical examination revealed local tenderness over the left iliac crest. Abdominal, respiratory, cardiovascular and neurological examinations were normal. An abdominal ultrasound showed that the liver was enlarged and that there were multiple echogenic lesions in the right lobe of the liver with varying diameters between 1 and 4 cm. The images suggested malignant lesions, either metastasis or HCC. Blood tests showed a high α-fetoprotein (AFP) level (50,000 IU/ml; normal range, <5.8 IU/ml). The PET/CT images showed focally increased 18F-FDG uptake in liver segments V and VII. In addition, multiple foci of increased 18F-FDG uptake in lytic bone lesions involving the vertebrae, ribs, pelvic bones and left femur with associated soft-tissue components were seen []. A pathological examination of biopsy material taken from the left eighth rib confirmed metastatic HCC [].