Hunt for the Primary—A Diagnostic Drive in Reverse Gear!!!

Skeletal metastasis from primary hepatocellular carcinoma is rare ranging from 03 to 20% and is mostly seen in autopsy cases. Patients presenting with symptoms of bone metastasis are still rarer. Only a few cases of metastasis to bone from hepatocellular carcinoma have been reported as per literature review. Other cancers like breast, prostate, and lung carcinomas show an increased incidence of metastasis to bone. The most favored sites for extrahepatic metastasis from hepatocellular carcinoma are lung, central nervous system, and lymph nodes. The most common sites for metastasis to bone from hepatocellular carcinoma are cranium and pelvic bones while the long bone (femur), as in the present case, is the most uncommon site for metastasis from hepatocellular carcinoma. A case of asymptomatic primary hepatocellular carcinoma presenting with pathological fracture due to tumour metastasis to femur is presented here for its rare and unique features.