Challenging the Assumption of Metastatic Disease: CT-Guided Lung Biopsy Enabling Liver-Directed Embolization Therapy in Hepatocellular Carcinoma

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Diagnosis and staging of malignancy guides treatment decisions. Concurrent primary malignancies are relatively common in the general population (1) and create diagnostic and therapeutic dilemmas. We report a unique case of a patient with recurrent hepatocellular carcinoma (HCC) and breast cancer with suspected metastatic disease to the lungs. However upon CT-guided biopsy by interventional radiology (IR), the lung nodules were found to be langerhans cell histiocytosis (LCH). After exclusion of extrahepatic disease, the patient was treated with bland embolization and radioembolization, which stabilized the liver disease until her death. This case demonstrates the role of radiology in the diagnosis and treatment of malignancy.

A 63 year-old female with recurrent HCC following microwave ablation 5 years prior and stereotactic body radiation therapy 1 year prior was referred to the IR service for consideration of trans-arterial radioembolization (TARE) as she was deemed to not be a suitable surgical candidate due to medical co-morbidities and extent of liver disease. During treatment planning, a CT thorax was ordered to assess for metastatic disease, which demonstrated numerous upper lung predominant cavitary nodules. These nodules were noted to be "concerning for metastasis". A nodule was subsequently biopsied with CT guidance and found to be pulmonary LCH. The location and cavitary nature of these nodules are typical for pulmonary LCH (2).

TARE is a minimally invasive option for patients with HCC who are not surgical or transplant candidates. The goals of TARE can vary from curative intent to downstaging the malignancy to bridging for transplantation (3). In this case, TARE was chosen to prevent progression in a patient suffering from numerous medical problems which precluded surgery. TARE has a low toxicity profile as opposed to systemic therapies (3, 4, 5). Therapy is also tailored to the patient based on size and number of lesions utilizing adjunct bland embolizations and advanced dosimetry (6).

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1973

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