{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T13:40:02Z","timestamp":1788615602117,"version":"build-2803163510"},"reference-count":34,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain\u2014especially with symptoms of paresthesia, radiculopathy, or cord compression\u2014in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.<\/jats:p>","DOI":"10.5858\/133.12.1975","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T09:15:36Z","timestamp":1613121336000},"page":"1975-1980","source":"Crossref","is-referenced-by-count":12,"title":["Hepatocellular Carcinoma Metastases to the Epidural Space"],"prefix":"10.5858","volume":"133","author":[{"given":"Hilary","family":"Somerset","sequence":"first","affiliation":[{"name":"From the Departments of Pathology (Drs Somerset and Kleinschmidt-DeMasters), Neurosurgery (Drs Witt and Kleinschmidt-DeMasters), and Neurology (Dr Kleinschmidt-DeMasters), University of Colorado Health Sciences Center, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Peter","family":"Witt","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Somerset and Kleinschmidt-DeMasters), Neurosurgery (Drs Witt and Kleinschmidt-DeMasters), and Neurology (Dr Kleinschmidt-DeMasters), University of Colorado Health Sciences Center, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bette K.","family":"Kleinschmidt-DeMasters","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology (Drs Somerset and Kleinschmidt-DeMasters), Neurosurgery (Drs Witt and Kleinschmidt-DeMasters), and Neurology (Dr Kleinschmidt-DeMasters), University of Colorado Health Sciences Center, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"issue":"4","key":"i1543-2165-133-12-1975-b1","series-title":"Cancer","first-page":"912","article-title":"The National Cancer Data Base Report on treatment patterns for hepatocellular carcinoma.","volume":"88","author":"Cance, W. G.","year":"2000","unstructured":"Cance, W. G., A. K.Stewart, and H. R.Menck. The National Cancer Data Base Report on treatment patterns for hepatocellular carcinoma.Cancer2000. 884:912\u2013920."},{"issue":"3","key":"i1543-2165-133-12-1975-b2","series-title":"Radiology","first-page":"698","article-title":"Extrahepatic metastases of hepatocellular carcinoma.","volume":"216","author":"Katyal, S.","year":"2000","unstructured":"Katyal, S., J. H.Oliver, M. S.Peterson, J. V.Ferris, B. S.Carr, and R. L.Baron. Extrahepatic metastases of hepatocellular carcinoma.Radiology2000. 2163:698\u2013703."},{"issue":"6","key":"i1543-2165-133-12-1975-b3","series-title":"Gastroenterology","first-page":"1752","article-title":"Diagnosis and treatment of hepatocellular carcinoma.","volume":"134","author":"El-Serag, H. B.","year":"2008","unstructured":"El-Serag, H. B., J. A.Marrero, L.Rudolph, and K. R.Reddy. Diagnosis and treatment of hepatocellular carcinoma.Gastroenterology2008. 1346:1752\u20131763."},{"issue":"4","key":"i1543-2165-133-12-1975-b4","series-title":"N Engl J Med","first-page":"378","article-title":"SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma.","volume":"359","author":"Llovet, J. M.","year":"2008","unstructured":"Llovet, J. M., S.Ricci, and V.Mazzaferro. et al. SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma.N Engl J Med2008. 3594:378\u2013390."},{"key":"i1543-2165-133-12-1975-b5","series-title":"J Neurooncol","first-page":"93","article-title":"Brain metastases from hepatocellular carcinoma in US patients.","volume":"76","author":"Seinfeld, J.","year":"2006","unstructured":"Seinfeld, J., A. S.Wagner, and B. K.Kleinschmidt-DeMasters. Brain metastases from hepatocellular carcinoma in US patients.J Neurooncol2006. 76:93\u201398."},{"issue":"4","key":"i1543-2165-133-12-1975-b6","series-title":"Eur J Neurol","first-page":"408","article-title":"Hepatocellular carcinoma presenting as nervous system involvement.","volume":"14","author":"Chen, S. F.","year":"2007","unstructured":"Chen, S. F., N. W.Tsai, and C. C.Lui. et al. Hepatocellular carcinoma presenting as nervous system involvement.Eur J Neurol2007. 144:408\u2013412."},{"issue":"32","key":"i1543-2165-133-12-1975-b7","series-title":"World J Gastroenterol","first-page":"5247","article-title":"Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.","volume":"12","author":"Doval, D. C.","year":"2006","unstructured":"Doval, D. C., K.Bhatia, and A. K.Vaid. et al. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.World J Gastroenterol2006. 1232:5247\u20135252."},{"issue":"2","key":"i1543-2165-133-12-1975-b8","series-title":"Dig Dis Sci","first-page":"308","article-title":"Asymptomatic advanced hepatocellular carcinoma presenting with spinal cord compression.","volume":"50","author":"Garcia, V. A.","year":"2005","unstructured":"Garcia, V. A. and R.Castillo. Asymptomatic advanced hepatocellular carcinoma presenting with spinal cord compression.Dig Dis Sci2005. 502:308\u2013311."},{"issue":"4","key":"i1543-2165-133-12-1975-b9","series-title":"Am J Med Sci","first-page":"233","article-title":"Case report: spinal cord compression due to metastatic hepatocellular carcinoma.","volume":"306","author":"Kantharia, B.","year":"1993","unstructured":"Kantharia, B., R.Nizam, H.Friedman, and S.Vardan. Case report: spinal cord compression due to metastatic hepatocellular carcinoma.Am J Med Sci1993. 3064:233\u2013235."},{"issue":"1","key":"i1543-2165-133-12-1975-b10","series-title":"J Neurooncol","first-page":"85","article-title":"Nervous system involvement by metastatic hepatocellular carcinoma.","volume":"36","author":"Kim, M.","year":"1998","unstructured":"Kim, M., D. L.Na, S. H.Park, B. S.Jeon, and J. K.Roh. Nervous system involvement by metastatic hepatocellular carcinoma.J Neurooncol1998. 361:85\u201390."},{"issue":"19","key":"i1543-2165-133-12-1975-b11","series-title":"World J Gastroenterol","first-page":"2758","article-title":"A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings.","volume":"13","author":"Tamaki, K.","year":"2007","unstructured":"Tamaki, K., I.Shimizu, and M.Urata. et al. A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings.World J Gastroenterol2007. 1319:2758\u20132760."},{"issue":"10","key":"i1543-2165-133-12-1975-b12","series-title":"Clin Radiol","first-page":"755","article-title":"MRI and CT of metastatic hepatocellular carcinoma causing spinal cord compression.","volume":"52","author":"Yang, W. T.","year":"1997","unstructured":"Yang, W. T., W.Yeo, S. F.Leung, Y. L.Chan, P. J.Johnson, and C.Metreweli. MRI and CT of metastatic hepatocellular carcinoma causing spinal cord compression.Clin Radiol1997. 5210:755\u2013760."},{"issue":"3","key":"i1543-2165-133-12-1975-b13","series-title":"Arch Pathol Lab Med","first-page":"490","article-title":"Application of immunohistochemistry to liver and gastrointestinal neoplasms: liver, stomach, colon, and pancreas.","volume":"132","author":"Geller, S. A.","year":"2008","unstructured":"Geller, S. A., D.Dhall, and R.Alsabeh. Application of immunohistochemistry to liver and gastrointestinal neoplasms: liver, stomach, colon, and pancreas.Arch Pathol Lab Med2008. 1323:490\u2013499."},{"issue":"14","key":"i1543-2165-133-12-1975-b14","series-title":"J Clin Oncol","first-page":"2137","article-title":"Patterns of cancer incidence, mortality and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world.","volume":"24","author":"Kamangar, F.","year":"2006","unstructured":"Kamangar, F., G. M.Dores, and W. F.Anderson. Patterns of cancer incidence, mortality and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world.J Clin Oncol2006. 2414:2137\u20132150."},{"issue":"2","key":"i1543-2165-133-12-1975-b15","series-title":"CA Cancer J Clin","first-page":"74","article-title":"Global Cancer Statistics, 2002.","volume":"55","author":"Parkin, D. 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National trends and disparities in the incidence of hepatocellular carcinoma, 1998\u20132003.Prev Chronic Dis2008. 53:A74."},{"issue":"4","key":"i1543-2165-133-12-1975-b1","series-title":"Cancer","first-page":"912","article-title":"The National Cancer Data Base Report on treatment patterns for hepatocellular carcinoma.","volume":"88","author":"Cance, W. G.","year":"2000","unstructured":"Cance, W. G., A. K.Stewart, and H. R.Menck. The National Cancer Data Base Report on treatment patterns for hepatocellular carcinoma.Cancer2000. 884:912\u2013920."},{"issue":"3","key":"i1543-2165-133-12-1975-b2","series-title":"Radiology","first-page":"698","article-title":"Extrahepatic metastases of hepatocellular carcinoma.","volume":"216","author":"Katyal, S.","year":"2000","unstructured":"Katyal, S., J. H.Oliver, M. S.Peterson, J. V.Ferris, B. S.Carr, and R. L.Baron. Extrahepatic metastases of hepatocellular carcinoma.Radiology2000. 2163:698\u2013703."},{"issue":"6","key":"i1543-2165-133-12-1975-b3","series-title":"Gastroenterology","first-page":"1752","article-title":"Diagnosis and treatment of hepatocellular carcinoma.","volume":"134","author":"El-Serag, H. B.","year":"2008","unstructured":"El-Serag, H. B., J. A.Marrero, L.Rudolph, and K. R.Reddy. Diagnosis and treatment of hepatocellular carcinoma.Gastroenterology2008. 1346:1752\u20131763."},{"issue":"4","key":"i1543-2165-133-12-1975-b4","series-title":"N Engl J Med","first-page":"378","article-title":"SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma.","volume":"359","author":"Llovet, J. M.","year":"2008","unstructured":"Llovet, J. M., S.Ricci, and V.Mazzaferro. et al. SHARP Investigators Study Group. 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Hepatocellular carcinoma presenting as nervous system involvement.Eur J Neurol2007. 144:408\u2013412."},{"issue":"32","key":"i1543-2165-133-12-1975-b7","series-title":"World J Gastroenterol","first-page":"5247","article-title":"Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.","volume":"12","author":"Doval, D. C.","year":"2006","unstructured":"Doval, D. C., K.Bhatia, and A. K.Vaid. et al. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.World J Gastroenterol2006. 1232:5247\u20135252."},{"issue":"2","key":"i1543-2165-133-12-1975-b8","series-title":"Dig Dis Sci","first-page":"308","article-title":"Asymptomatic advanced hepatocellular carcinoma presenting with spinal cord compression.","volume":"50","author":"Garcia, V. A.","year":"2005","unstructured":"Garcia, V. A. and R.Castillo. Asymptomatic advanced hepatocellular carcinoma presenting with spinal cord compression.Dig Dis Sci2005. 502:308\u2013311."},{"issue":"4","key":"i1543-2165-133-12-1975-b9","series-title":"Am J Med Sci","first-page":"233","article-title":"Case report: spinal cord compression due to metastatic hepatocellular carcinoma.","volume":"306","author":"Kantharia, B.","year":"1993","unstructured":"Kantharia, B., R.Nizam, H.Friedman, and S.Vardan. Case report: spinal cord compression due to metastatic hepatocellular carcinoma.Am J Med Sci1993. 3064:233\u2013235."},{"issue":"1","key":"i1543-2165-133-12-1975-b10","series-title":"J Neurooncol","first-page":"85","article-title":"Nervous system involvement by metastatic hepatocellular carcinoma.","volume":"36","author":"Kim, M.","year":"1998","unstructured":"Kim, M., D. L.Na, S. H.Park, B. S.Jeon, and J. K.Roh. Nervous system involvement by metastatic hepatocellular carcinoma.J Neurooncol1998. 361:85\u201390."},{"issue":"19","key":"i1543-2165-133-12-1975-b11","series-title":"World J Gastroenterol","first-page":"2758","article-title":"A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings.","volume":"13","author":"Tamaki, K.","year":"2007","unstructured":"Tamaki, K., I.Shimizu, and M.Urata. et al. A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings.World J Gastroenterol2007. 1319:2758\u20132760."},{"issue":"10","key":"i1543-2165-133-12-1975-b12","series-title":"Clin Radiol","first-page":"755","article-title":"MRI and CT of metastatic hepatocellular carcinoma causing spinal cord compression.","volume":"52","author":"Yang, W. T.","year":"1997","unstructured":"Yang, W. T., W.Yeo, S. F.Leung, Y. L.Chan, P. J.Johnson, and C.Metreweli. 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