Unresectable Ectopic Hepatocellular Carcinoma Treated with Sorafenib

Abstract

Ectopic hepatocellular carcinoma (HCC) is a rare malignancy, which manifests similar morphology and immunohistochemistry to intrahepatic HCC. Herein, we report a case of ectopic HCC in a 73-year-old male. The patient presented to our hospital with gradually progressing right lower abdominal pain, and enhanced computed tomography revealed multiple nodules in the peritoneum without intrahepatic mass. A diagnostic laparoscopy was performed, and the final pathology result confirmed that it was HCC. Additional laboratory tests showed elevated serum alpha-fetoprotein and protein induced by vitamin K absence-II (PIVKA-II) levels, suggesting our diagnosis. The patient received sorafenib, a tyrosine kinase inhibitor (TKI), for unresectable ectopic HCC. However, the tumor progressed, and because of tarry stools and hemorrhagic anemia, sorafenib was ceased after 7 months of therapy. One month after the cessation of sorafenib, the PIVKA-II level increased abruptly, and the patient died 1 year after diagnosis. 227The effective treatment for unresectable ectopic HCC is still unknown. Additional cases should be accumulated to determine the effect of TKI on ectopic HCC.

Challenge in Diagnosis and Treatment of Ectopic Hepatocellular Carcinoma: A Case Report and Literature Review

“…The early symptom of EHCC is hard to find, since the presentation is often silent until symptoms such as compression, pain, and bleeding occur. It is usually in the advanced stage when patients come to a hospital ( 8 , 10 ). Our patient visited the hospital because of epigastric discomfort and regurgitation.…”

“…Although no lesion was found in the mother liver at the time of initial treatment, TACE was an option to prevent recurrence. Metastatic EHCC was reported on 5 patients ( 7 , 8 , 10 , 13 , 14 ). Only one of them showed no sign of recurrence after treatment ( 14 ).…”

Ectopic Hepatocellular Carcinoma Manifesting as Paraspinal Mass: An Unusual Entity

“…Other possible treatment options include sorafenib. 5 Our case highlights the diagnosis and management of ectopic HCC and reflects upon the fact how this rare tumor if diagnosed early can be managed by surgery.…”

A large ectopic hepatocellular carcinoma with adrenal infiltration: a rare case report

“…Of the 29 patients including this case, 26 patients underwent surgery treatment ( 1 , 3 – 8 , 10 – 15 , 17 , 18 , 20 – 29 ) and two patients did not undergo surgery due to serious complications ( 9 , 19 ). Traditional laparotomy and laparoscopy can be performed as the surgical methods, and seven patients received adjuvant therapy after surgery ( 5 , 11 , 15 , 24 , 25 , 27 ). For unresectable hepatocellular carcinoma, lenvatinib or sorafenib can be used as targeted drugs for adjuvant therapy in EHCC ( 30 ).…”