Heterogeneous Tumor Profiles in Hepatocellular Carcinoma: An Example of Late Recurrences With Genetically Distinct Tumors Over a 10-Year Survival

ABSTRACT Tumor profiling and genetic sequencing of hepatocellular carcinoma (HCC) is not routinely performed clinically, as targetable mutations are rare. We present a case where next-generation sequencing demonstrated two genetically distinct late recurrences of HCC. The first recurrence was characterized by a destructive spinal metastasis 3 years after initial presentation of ruptured HCC; the second recurrence, a small intraheptic mass, was found on surveillance imaging 8 years after initial presentation. These two recurrences were shown to have completely distinct tumor profiles. This unique case highlights the clinical insight offered by next-generation sequencing in patients who develop late recurrence with prolonged survival.