A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma

Abstract

We report herein a 5-year survivor after the resection of peritoneal metastases from pedunculated hepatocellular carcinoma (HCC). A 42-year-old man underwent lateral segmentectomy of the liver, with a diagnosis of pedunculated HCC, on October 10, 1994. The lesion was associated with intratumoral hemorrhage and was covered by the greater omentum, but there were no peritoneal metastases. The patient was readmitted to our hospital 4 months later with right upper quadrant pain. His serum alpha-fetoprotein level was 3ng/dl. Hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCV-Ab) were both negative. Abdominal computed tomography (CT) revealed two nodular lesions in the right upper abdominal cavity. He was diagnosed with peritoneal metastases from HCC. Because there were no other distant metastases, laparotomy was performed to resect these tumors. We found two other tumors, located in the mesentery of the appendix and ileum. All four tumors were resected by partial transverse colectomy and appendectomy. The histopathology of the tumors showed poorly differentiated HCC (Edmondson-Steiner's grade III). The patient has been doing well without recurrent disease for more than 5 years after the second operation. The prognosis of patients with pedunculated HCC is poor. Furthermore, resection for peritoneal metastases from HCC is rare because of the presence of multiple seeding in the abdominal cavity and distant organ metastases. To our knowledge, our patient is the longest survivor after resection of peritoneal metastases from pedunculated HCC.

18F-FDG PET in the detection of extrahepatic metastases from hepatocellular carcinoma

“…Furthermore, surgical resection may be effective in selected patients with isolated extrahepatic recurrence of HCC and possibly offers the only chance of long-term survival. [5][6][7][8][9][10] Positron emission tomography (PET) with 18 F-fluoro-2-deoxy-d-glucose ( 18 F-FDG) is a useful imaging tool for diagnosis, initial staging, and restaging of a variety of malignancies. 18 F-FDG PET is, however, less successful in the detection of primary HCC because of variable 18 F-FDG uptake in HCC.…”

Combination Therapy of Oral Fluoropyrimidine Anticancer Drug S-1 and Interferon Alpha for HCC Patients with Extrahepatic Metastases

“…Though there is no standard treatment for extrahepatic metastases of primary HCC, several groups have reported the use of various treatment modalities for extrahepatic metastases [43,44,45,46,47,48,49,50]. In this regard, few HCC patients can undergo curative surgical resection of extrahepatic metastases because of hepatic reserve or intrahepatic tumor stage [45,46,47,48,49]. HCC is thought to spread mainly via the hematogenous route and causes intra/extrahepatic metastases.…”

Renal Invasion Of Hepatocellular Carcinoma: Report Of A Case

“…Extrahepatic metastases are usually associated with the advanced disease and there are only palliative treatment choices such as chemotheraphy or transcatheter chemoembolization for these patients (1,2). Extrahepatic tumor growth with direct invasion of adjacent structures is rarely reported in the literature (3)(4)(5)(6)(7)(8)(9). Inadequate assessment before surgery, preoperatively missed occult tumors, insufficient therapy, insufficient tumor resection or the aggresive nature of the tumor may lead to early recurrence after treatment.…”

“…Extrahepatic growth of HCC (pedunculated HCC) is seen approximately 0.24%-3 % of the cases and the long-term prognosis of this form is quite poor (6). It can be defined as a protruding mass on the surface of the liver with a risk of spontaneous rupture (6,15).…”

“…It can be defined as a protruding mass on the surface of the liver with a risk of spontaneous rupture (6,15). Besides peritoneal implantation due to the rupture, direct invasion of the adjacent structures may occur.…”