hip joint and femur metastases as the first symptom of hepatocellular carcinoma detected by bone scintigraphy

Although bone involvement is reported as uncommon in hepatocellular carcinoma (HCC), its incidence has significantly increased in the last decade due to the improvement of overall survival of these patients. Bone metastasis is discovered as the first symptoms in about 5%–7% of the HCC patients, which would cause clinical misdiagnosis easily. In this case report, the patient was diagnosed as primary femoral benign tumor initially. Axial skeleton is the most frequent localization of bone metastases, but hip joint and femur metastases were rare reported. Bone scintigraphy can be an option for patients to reduce the misdiagnosis rate and to rule out the possibility of bone metastasis from HCC.