Hepatocellular Carcinoma Presenting as a Pancreatic Head Mass

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Abstract
Hepatocellular carcinoma (HCC) spreading to the pancreas is rare and, when it does occur, is most often detected as a late finding at autopsy. We report the first case of HCC initially presenting as a pancreatic mass. Computed tomography (CT) scan showed a 7-cm mass in the dome of the liver and a 3-cm pancreatic head mass causing biliary and duodenal obstruction. Palliative surgery was performed to bypass the pancreatic obstruction. During the operation, fine needle aspiration (FNA) was performed on the pancreatic mass. The liver mass was sampled by percutaneous ultrasound-guided biopsy. Postoperatively, the patient's obstructive symptoms were relieved. The histologic studies showed that both the liver and the pancreatic masses consisted of poorly differentiated HCC that stained positive for alpha-fetoprotein. The rarity and the implications of this presentation are discussed.