A Case Report of Pedunculated Hepatocellular Carcinoma, and Reveiw of 62 Cases Reported in the Japanese Literature

Abstract

A 71-year-old man visited our hosptial with the chief complaint of a mass in the left epigastric region. MDL revealed a compresed area ranging from the fundus ventriculi to the corpus ventriculi, and CT revealed a giant mass with an uneven interior. Angiography revealed dilatation of the celiac, splenic and hepatic arteries and indicated that the tumor mass was nourished mainly by the splenic artery. Because gastric sarcoma was suspected, surgery was performed on the patient. The mass, which was found to have developed extramurally, was connected with the diaphragm and the left lobe of liver. The left lobe and part of the diaphragm were resected, together with total gastrectomy. Histopathologicaly examination revealed that the tumor originating from the left lobe of the liver had developed extensively and extended extrahepatically. It was evaluated as Ed-grade II to III hepatocellular carcinoma with infiltration into the anterior wall of the stomach. Three months after surgery the patient was discharged from the hospital, but the metastatic lesions to the liver gradually enlarged. In spite of the injection of mitomycin C or lipiodol into the hepatic artery, the patient died of liver failure seven months after surgery.The present case of liver cancer with extrahepatic development, a relatively rare condition, is discussed with a review of 62 cases reported in the Japanese literature and with reference to other literature.

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

“…1,2 In a review of 62 patients with pedunculated HCC carried out by Touchika et al, 12 intrahepatic recurrence was observed in 22 patients (35.4%), and distant organ metastases was seen in 14 patients (22.5%). 12 Based on the high incidence of the presence of portal vein infiltration and intrahepatic metastases in resected specimens and the prognosis after hepatectomy, Kan et al 13 reported that systematic hepatectomy was more suitable than partial hepatectomy as a treatment modality for pedunculated HCC. From these observations, we believe that the lack of recurrence in the remnant liver in our patient may have been, in part, dependent on the surgical procedure selected.…”