Intraperitoneal metastasis of hepatocellular carcinoma after spontaneous rupture: A case report

Abstract

INTRODUCTIONHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. It is usually manifested in the 6th and 7th decades of life. Extrahepatic metastases are seen in 64% of patients with HCC. The most frequent sites of extrahepatic metastases are lung, abdominal lymph node and bone, but peritoneal dissemination is unusual [1,2] . The incidence of spontaneous rupture of HCC is about 8%-26% in Asia [3][4][5] and the mortality rate of HCC patients is 10% [6] . However, peritoneal metastasis of HCC after spontaneous rupture is seldom noted. Here, we report a case of intraperitoneal metastasis of HCC after spontaneous rupture 10 mo ago, which was treated with transarterial embolization. CASE REPORTA previously asymptomatic 72-year-old man had a history of chronic hepatitis C-related liver cirrhosis without regular follow-up. Sudden nausea and vomiting with watery diarrhea were noted on January 2006. Then he was sent to Yun-Lin Branch of National Taiwan University Hospital for help. Abdominal computer tomography (CT) scan showed a huge HCC that was suspicious of rupture. Under the request of his family, he was transferred to our hospital and transarterial embolization was performed on January 31, 2006. After discharge, he was regularly followed up at our Gastrointestinal (GI) Outpatient Department (OPD). Dull abdominal pain over the right upper quadrant area, accompanied with fullness sensation, was noted in November 2006. Besides, he also had body weight loss of about ten kilograms in one year. So he visited our hospital again. Abdominal CT scan revealed a peritoneal mass in the right upper quadrant peritoneal area and hepatoma recurrence was considered ( Figure 1). Transarterial embolization was arranged again, but failed. After consultation with the surgeon, he was admitted for surgical resection.Surgical intervention was arranged on January 24, 2007. Operative methods were segmental hepatectomy (S6 and partial S5), excision of extrahepatic tumor, and cholecystectomy. The operation showed a huge tumor (12 cm × 8 cm × 6 cm) over the right upper quadrant area just below liver parenchyma (Figure 2) with its blood supplied from the omentum. Besides, two small mass lesions (3 cm × 2 cm and 2 cm × 1 cm) were found over AbstractRupture of hepatocellular carcinoma (HCC) is a lifethreatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spontaneous rupture. A previously asymptomatic 72-yearold man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomography (CT) scan showed a huge peritoneal mass over the right upper quadrant area. Surgical resection was arranged and subsequent microscopic examination confirmed a diagnosis of moderately-differentiated HCC.

Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization

“…Peritoneal metastasis from HCC is rare, but tumor implantation on the peritoneal surfaces occurs after HCC rupture (17,(23)(24)(25)(26)(27)(28). Our results showed that peritoneal implantation after HCC rupture was not rare.…”

Peritoneal carcinomatosis secondary to spread of hepatocellular carcinoma originated upon a healthy liver

“…Intraperitoneal metastases are rare but their risk is elevated in tumor rupture. If the peritoneal implant is unique, which is the most common form of presentation, the treatment of choice is resection (4,5). The singularity of the case described here is the debut as acute hemoperitoneum together with multiple peritoneal dissemination.…”

Risk Factors, Clinical Features, and Prognosis of the Hepatocellular Carcinoma with Peritoneal Metastasis

“…Another suggested mechanism is that rupture of exophytic HCC into the peritoneal cavity can cause subsequent seeding of a metastatic deposit. This was only suggested in several case studies and a small number of clinical studies [7,[10][11][12][13][14]. Therefore, we still do not know exactly whether percutaneous procedures or HCC rupture are risk factors of PM in HCC patients.…”