A rare presentation of hepatocellular carcinoma: Cervical and destructive thoracic paravertebral masses.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, commonly arising in cirrhotic livers and presenting with hepatic or constitutional symptoms. Extrahepatic spread is less common, and paravertebral soft tissue involvement is exceedingly rare. We report a 55-year-old man with chronic hepatitis B virus infection who presented with a 2-month history of progressive left-sided neck swelling and left upper limb weakness with paresthesia. Laboratory evaluation revealed newly identified liver dysfunction, including normocytic anemia, transaminitis, and hyperbilirubinemia. Imaging demonstrated a left cervical paravertebral mass at C6-C7 with neural foraminal extension, a destructive right lower thoracic paravertebral lesion, and a hypervascular hepatic mass. Histopathology of the cervical lesion confirmed metastatic HCC, and the patient was staged as IVB, with plans for systemic chemotherapy and palliative radiotherapy. This case illustrates the diagnostic challenge of atypical HCC presentations in regions with high hepatitis B virus endemicity, where extrahepatic manifestations may precede classical hepatic symptoms. High clinical suspicion, early biopsy, and a multidisciplinary approach are essential for diagnosis and management, particularly in resource-limited settings.