A 72-year-old male, former smoker and active drinker, with a history of chronic hepatitis C virus (HCV) liver disease without progression to cirrhosis.
Three months before admission, the patient suddenly presented pain and functional impotence in the right shoulder after unnoticed exertion.
With the initial clinical judgment of rotator muscle cuff rupture, immobilization of the extremity and analgesic treatment were performed. The persistence of the symptoms led to the realization of a radiological echography of the proximal metafibrin bone fracture.
After anamnesis, the patient reported at that time a constitutional syndrome of several months; physical examination revealed a flat, mucocutaneous nodule. The patient reported a "charretera" shape of the right shoulder, progressive hepatomegaly of 5 cm.
Analytically, the patient had abnormal liver biochemistry (AST: 142 IU/l; ALT: 110 IU/l; bilirubin: 9.82 mg/dl), while the abdominal computerized tomography (CT) revealed a large cauda solid liver mass.
Levels of α-fetoprotein (αFP) were normal (8.8 ng/ml).
Bone scintigraphy (99mTc) showed hypercaptation in proximal right metaphysis and third lumbar vertebra.
A puncture-aspiration with needle (PAAF) was performed on the soft tissue lesion adjacent to the latter, with histological examination showing metastasis of HCC.
After proceeding to osteosyntheses of the fractuary focus by means of a Rusell-Taylor medullary nail, systemic treatment with tamoxifen was initiated, and the patient died four months later.
