Hepatocellular carcinoma associated with hemorrhaging from iatrogenic rupture of a rib metastasis

Detecting a rib metastasis as a first manifestation before identifying hepatocellular carcinoma (HCC) is rare. We report an HCC with massive bleeding from the biopsied rib tumor. A 68-year-old man was referred for right chest pain. Computed tomography showed a mass in the rib and two small masses in the liver. The biopsied rib continued to bleed, so we removed the entire tumor, including the rib. We histologically confirmed the diagnosis as rib metastasis from the HCC. The patient died 3 months after the onset. We caution against performing an incisional biopsy without due consideration.