Ectopic Hepatocellular Carcinoma Arising in the Left Triangular Ligament of the Liver

Abstract

Hepatocellular carcinoma (HCC) rarely originates in extrahepatic liver tissue. Laparoscopic resection is widely used to treat HCC. This report presents a case of a patient with ectopic HCC arising in the left triangular ligament of the liver that was successfully treated by laparoscopic resection. A 59-year-old female presented with an elevated serum alpha-fetoprotein (AFP) level (2,508 ng/ml). Dynamic computed tomography demonstrated a tumor measuring 20 mm in diameter below the left diaphragm just adjacent to the spleen. The tumor showed contrast enhancement in the hepatic arterial phase and became less dense than the liver parenchyma in the portal phase. The patient was diagnosed with ectopic HCC arising in the left diaphragm and laparoscopic surgery was performed. The tumor was located in the left triangular ligament of the liver and had a stalk between the tumor and the liver. The tumor was resected, and the final diagnosis was moderately differentiated ectopic HCC arising in the left triangular ligament of the liver. The patient had an uneventful postoperative recovery and has experienced no recurrence over 18 months after the operation.

Multiple Ectopic Hepatocellular Carcinomas Arising in the Abdominal Cavity

“…The incidence of ectopic liver tissue has been reported to be 0.24–0.47% [3, 4]. Ectopic liver is a very rare entity, usually asymptomatic, but occasionally it causes unexpected problems such as intra-abdominal bleeding at the site of origin and hepatocarcinogenesis.…”

Unresectable Ectopic Hepatocellular Carcinoma Treated with Sorafenib

“…Ectopic HCC is a rare malignancy, with morphology and immunohistochemistry similar to those of intrahepatic HCC. However, HCC development in ectopic liver is less commonly associated with risk factors for HCC arising in the mother liver, including hepatitis B virus or hepatitis C virus infection, alcohol abuse, and cirrhosis [2][3][4][5], which were all absent in our case.…”

“…In the present case, the diagnosis was made by histopathological examination of surgical specimens, and by serum AFP level exceeding 1,000 ng/ml measured after pathological diagnosis. In previous reports, serum AFP levels exceeding 1,000 ng/ml were found in 20 out of 46 ectopic HCC cases (43%), which is higher than that in general HCC (28%), rendering that high serum AFP levels may provide hints for the diagnosis [1,5].…”

“…To fully support the diagnosis of ectopic HCC, non-cancerous liver parenchyma should be identified around the HCC [6][7][8]. However, non-cancerous tissue is reported in only a few cases [2,5,9]. Since most cases show absence of non-cancerous tissue [10], it is suspected that the malignant cells have fully expanded and replaced the ectopic liver [5,6,10].…”

“…However, non-cancerous tissue is reported in only a few cases [2,5,9]. Since most cases show absence of non-cancerous tissue [10], it is suspected that the malignant cells have fully expanded and replaced the ectopic liver [5,6,10]. Despite the fact that non-cancerous tissue was not found in our case, no HCC could be identified in the mother liver by several techniques, including sonography, CT, magnetic resonance imaging, either at the time of diagnosis or during the follow-up afterward, confirming the diagnosis of ectopic HCC.…”