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Small experimental trials or case reports have been published to date, reporting partial response or stable disease course for several months; however, these results need validation in larger controlled studies [2, 5, 15�C17]. Although HPC has been described as borderline malignant, its clinical behavior is difficult to predict and long-term follow-up is indicated, since recurrence and metastasis have been reported even after prolonged disease-free intervals [1, 9, 18]. Factors affecting prognosis are mainly tumor grade and completeness of resection; however, in multivariate analysis, they do not reach statistical significance in most papers due to small sample sizes [9]. Comparison between low- and high-grade tumors has shown that even grade II tumors have significant metastatic potential and often relapse [3]. High-grade tumors recur earlier than low-grade tumors and decrease OS rates MS-275 molecular weight [9, 11]. The survival benefit of gross total resection applies to both CNS and extra-CNS HPCs, although extra-CNS tumors tend to be larger and more advanced and with shorter OS [12]. In their study, Damodaran et al. reported OS at 5, 10, 15, and 20 years at 79%, 56%, 44%, and 22%, respectively [19]. For grade II tumors, OS was 216 months, while for grade III tumors OS was 142 months. Local recurrence learn more rates at 5, 10, and 15 years were 20%, 54%, and 77%, while distant metastasis rates at 5, 10, and 15 years were 10%, 31%, and 77%. Although liver metastatic disease is a surrogate marker of tumor hematogenous dissemination, long-term survival after hepatectomy is reported. Extrahepatic disease is not a contraindication to liver resection in case of local control, as reported in our case. In essence, if the time interval between the primary lesion and the liver metastatic disease is prolonged, major hepatectomy is justified in young individuals. In case of liver recurrence, re-resection combined with TAE is highly recommended, due to the hypervascular nature Quinapyramine of the tumor [20]. Consent This paper is published with the written consent of the patient. Conflict of Interests The authors declare no conflict of interests.A 48-year-old male with history of mild gastroesophageal reflux disease presented to the emergency with a one-month history of worsening low back pain without a preceding trauma. The pain had gradually increased to 10/10 in severity and impaired his ambulation over the previous 2 days. He denied any lower extremity pain, weakness, numbness or tingling, or fecal or urinary incontinence. He also reported right chest discomfort that began with a ��painful crack�� while he was bowling about a week before. His backache and chest pain did not improve with a brief course of NSAIDs. He denied nausea, vomiting, hematochezia, melena, or weight loss. His family history was negative for any malignancies.
