A 66-year-old male, active smoker, with a history of partial gastrectomy for ulcerative disease and chronic HCV liver disease in periodic follow-up.
She was admitted due to gastrointestinal bleeding in the form of melenas accompanied by pain in the right hip of several weeks of evolution, irradiated by the anterolateral aspect of the thigh to the right hip. Both basic biochemical levels of the femoral head were normal.
Abdominal CT showed a mass of 8 x 7 x 5 cm in the right liver lobe with heterogeneous contrast uptake, suggestive of HCC. Conventional radiology of the pelvis and hip, on the other hand, revealed a femoral neck-polylated level.
The bone scintigraphy (99mTc) confirmed the pathological accumulation of radiotracer at this level, as well as in the left supraorbital region.
Finally, the histological study by biopsy of the lesion in the femoral neck confirmed the diagnosis of metastasis of HCC.
The primary tumor was chemoembolized, associated with radiotherapy over the hip joint (total dose of 2,400 cGy), with evident symptomatic improvement.
Six months later the patient presented a subtrochanteric pathological fracture that required osteitis by means of a PFN nail and died 20 weeks after the intervention.
