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Case presentation A Tunisian man in his 70s with undiagnosed chronic hepatitis B presented with back pain and was diagnosed with multifocal hepatocellular carcinoma. His course was complicated by acute paraplegia from spinal cord compression due to vertebral metastases. Conclusion The report highlights atypical HCC presentations and the need for vigilance when unexplained bone or neurological symptoms occur without overt hepatic signs.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/vertebral-metastasis-with-spinal-cord-compression-as-the-first-manifestation-of-hepatocellular-carcinoma-a-case-report/356330/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/vertebral-metastasis-with-spinal-cord-compression-as-the-first-manifestation-of-hepatocellular-carcinoma-a-case-report/356330.png","ImageObject",300,407,{"name":92,"@type":93},"Hazel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is this hepatocellular carcinoma case considered unusual?","Question",{"text":113,"@type":114},"Hepatocellular carcinoma typically presents with liver-related symptoms, and bone metastases are uncommon as the first sign. Here, vertebral metastasis with spinal cord compression was the initial manifestation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What symptoms led to the diagnosis in the reported patient?",{"text":118,"@type":114},"The patient presented with new-onset inflammatory thoracolumbar back pain that progressively worsened and became refractory to analgesics, along with fatigue, weight loss, and anorexia.",{"name":120,"@type":111,"acceptedAnswer":121},"How did the patient develop paraplegia?",{"text":122,"@type":114},"Acute paraplegia occurred due to spinal cord compression caused by vertebral metastases, which complicated the clinical course after the cancer diagnosis.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},356330,1790410874,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},137441390410,"https://ap-avatar.wpscdn.com/avatar/2000252f4ab5702993?_k=1776741390130283984","Hajer etal. Journal of Medical Case Reports (2026) 20:76  \n[https://doi.org/10.1186/s13256-025-05758-2](https://doi.org/10.1186/s13256-025-05758-2)  \nJournal of Medical Case Reports  \n CASE REPORT Open Access  \nVertebral metastasis with spinal cord compression as the first manifestation of hepatocellular carcinoma: a case report  \nHassine Hajer 1, Khemiri Wafa1* , Gnichi Asma2, Yacoub Haythem 1, Cherif Douha1, Kchir Hela1, Dabbebi Habiba 1 and Maamouri Nadia 1  \nAbstract  \nBackground Hepatocellular carcinoma, typically linked to chronic hepatitis B or C, usually presents with liver-related symptoms, mainly jaundice, abdominal pain, and weight loss, and rarely spreads beyond the liver. Bone metastases and their complications are uncommon and seldom the initial sign.  \nCase presentation We report the case of a North African (Tunisian) man in his 70s with undiagnosed chronic hepatitis B who presented with back pain and was subsequently diagnosed with multifocal hepatocellular carcinoma. His clinical course was complicated by acute paraplegia due to spinal cord compression caused by vertebral metastases. Conclusion This case highlights the variability in hepatocellular carcinoma presentations and underscores the need for heightened clinical vigilance in patients presenting with unexplained bone or neurological symptoms, even in the absence of overt hepatic signs. Skeletal metastases are rare in this tumor compared with other cancers. The diagnosis can be even more challenging when bone metastases are the predominant initial manifestation, particularly when neurological complications emerge early in the course of disease.  \nKeywords Hepatocellular carcinoma, Chronic hepatitis B, Paraplegia, Skeletal metastasis, Case report  \nIntroduction  \nHepatocellular carcinoma (HCC) accounts for approximately 90% of primary liver cancers and most often develops in the setting of chronic liver disease, particularly after progression to cirrhosis [1]. Despite advancesin surveillance and imaging, HCC is often diagnosed at an advanced stage due to its insidious onset and the absence of specific early symptoms. As a result, extrahepatic metastases are increasingly recognized at the time of diagnosis [2]. Bone metastasis as the initial  \n*Correspondence:  \nKhemiri Wafa[khemiri.wafa00@gmail.com](khemiri.wafa00@gmail.com)  \n1 Department of Gastroenterology B, La Rabta University Hospital, Tunis, Tunisia  \n2 Department of Radiology, La Rabta University Hospital, Tunis, Tunisia  \nmanifestation of HCC is uncommon [3]. We report an unusual case of spinal cord compression due to vertebral metastases, unveiling an unknown HCC.  \nCase presentation  \nA North African (Tunisian) man in his 70s, with a 20-year history of chronic obstructive pulmonary disease managed with inhaled corticosteroids and bronchodilators, had no personal or family history of hepatobiliaryor metabolic disease and denied exposure to hepatotoxic risk factors including alcohol, illicit drugs, or high-risk sexual behavior. He presented with new-onset inflammatory thoracolumbar back pain over the past 3 weeks, described as a dull, persistent aching sensation that did not radiate. It was initially rated 5/10 on a visual analog scale, progressively worsened, and became refractory to analgesic therapy. He reported associated fatigue, weight  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unle","cbCaikwCgVuLFwiz","https://ap.wps.com/l/cbCaikwCgVuLFwiz","pdf",1049189,"English","# Abstract\n# Introduction\n# Case presentation\n## Background and presentation\n## Examination and investigations\n# Discussion","[{\"question\":\"Why is this hepatocellular carcinoma case considered unusual?\",\"answer\":\"Hepatocellular carcinoma typically presents with liver-related symptoms, and bone metastases are uncommon as the first sign. Here, vertebral metastasis with spinal cord compression was the initial manifestation.\"},{\"question\":\"What symptoms led to the diagnosis in the reported patient?\",\"answer\":\"The patient presented with new-onset inflammatory thoracolumbar back pain that progressively worsened and became refractory to analgesics, along with fatigue, weight loss, and anorexia.\"},{\"question\":\"How did the patient develop paraplegia?\",\"answer\":\"Acute paraplegia occurred due to spinal cord compression caused by vertebral metastases, which complicated the clinical course after the cancer diagnosis.\"}]","Vertebral metastasis with spinal cord compression as the first manifestation of hepatocellular carcinoma - a case report | PDF",1790124789,13]