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

Abstract

BackgroundFindings of ectopic hepatocellular carcinoma (EHCC) have been rarely documented. Complicated clinical features and unpredictable medical prognosis make diagnosis and treatment difficult.Case PresentationWe reported a 59-year-old male patient who came to the hospital with epigastric discomfort and regurgitation of gastric acid. An enhanced CT scan revealed a 1.8 cm × 1.4 cm mass in the tail of pancreas without any positive finding in the liver. Postoperative MRI scan was performed but did not reveal any evidence of hepatic tumor. The tumor was resected in toto. Meanwhile, a 1 cm × 1 cm mass in the body of the stomach was found that was removed simultaneously. Histopathology showed that the pancreatic tumor was ectopic hepatocellular carcinoma (EHCC), and that the gastric nodule was gastrointestinal stromal tumor (GIST). The patient had an uneventful postoperative recovery. He has been living without recurrence for over 7 years since surgery. Owing to our knowledge, this is the second-longest disease-free survival time for EHCC in the literature.ConclusionHere, we present a rare case of EHCC in the pancreas, and review the current literature on EHCC. Operation was an effective treatment for patients with curable EHCC. EHCC with metastasis still needs more practice to improve the poor prognosis.

An ectopic hepatocellular carcinoma arising from the gallbladder: a rare case report

“…Furthermore, serum AFP levels were found to be elevated in 10 out of 19 cases (52.6%, AFP > 20 ng/mL), with 4 out of 19 cases exhibiting a serum AFP level exceeding 1,000 ng/mL (21.1%). These ndings are consistent with the studies conducted by Fabio (54%, AFP > 20 ng/mL) and the Liver Cancer Study Group of Japan (28%, AFP > 1000 ng/mL) [4,12]. It is noteworthy that besides its diagnostic utility for EHCC, AFP can also serve as a prognostic indicator for patients [4][5][14][15][16].…”

“…Meanwhile, the tail acts as a precursor for the bile duct system, differentiating into both gallbladder and common bile duct before ultimately merging with pancreatic duct to open in duodenum. Therefore, any abnormality in liver development can lead to EL formation, for example, when the bile duct and dorsal pancreatic bud are formed from the foregut and when the ventral pancreatic bud is formed from the bile duct, EL may form around the gallbladder wall and pancreas [9][10][11][12].…”

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

“…The incidence rate of ectopic liver is about 0.24% to 0.47%. When we searched for “ectopic hepatocellular carcinoma” as a “Text Word” in PubMed, only 28 full-text case reports written in English were obtained ( Table 2 ) ( 1 , 3 – 29 ). Ectopic liver tissue can occur in the adrenal gland, pancreas, peritoneum, gallbladder, bile duct, thoracic cavity, abdominal cavity, diaphragm, spleen, and chest wall, of which the diaphragm is the most common site ( 12 , 13 , 16 , 20 , 24 , 27 , 29 ).…”

“…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 ).…”

“…Ectopic hepatocellular carcinoma (EHCC) is defined as hepatocellular carcinoma arising from the hepatic parenchyma located in an extrahepatic organ or tissue ( 1 ). It is reported that the incidence of ectopic liver during laparoscopy or autopsy ranges from 0.24% to 0.47% ( 2 ).…”