Hepatocellular carcinoma presenting with pathologic fracture due to bone metastases

Two cases of hepatocellular carcinoma presenting with pathologic fracture due to bone metastases are reported. The patients did not exhibit clinical evidence of liver disease on presentation, and there was no previous history of liver disease. Liver function tests were normal in 1 case, while in the other the only abnormality was a slightly raised alkaline phosphatase. In 1 case the diagnosis was made by needle biopsy of a metastatic bone lesion, and in the other only at autopsy. The literature concerning this mode of presentation of hepatocellular carcinoma, and of liver cell carcinoma with skeletal metastases is reviewed. It is considered that hepatocellular carcinoma should be included in the differential diagnosis of carcinoma metastatic to bone.