Multiple Ectopic Hepatocellular Carcinomas Arising in the Abdominal Cavity

Abstract

Ectopic hepatocellular carcinoma (HCC) is a very rare clinical entity that is defined as HCC arising from extrahepatic liver tissue. This report presents a case of ectopic multiple HCC arising in the abdominal cavity. A 42-year-old otherwise healthy male presented with liver dysfunction at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. Laboratory examination showed elevations in serum alpha-fetoprotein and PIVKA-II. Ultrasonography and computed tomography revealed multiple nodular lesions in the abdominal cavity with ascites without a possible primary tumor. Exploratory laparoscopy was performed, which revealed bloody ascites and multiple brown nodular tumors measuring approximately 10 mm in size that were disseminated on the perineum and mesentery. A postoperative PET-CT scan was performed but it did not reveal any evidence of a tumor in the liver. The tumors resected from the peritoneum were diagnosed as HCC. The present case of HCC was thought to have possibly developed from ectopic liver on the peritoneum or mesentery.

Ectopic hepatocellular carcinoma in the gallbladder

“…However, risk factors such as hepatitis B or C and cirrhosis seem more uncommon -in fact, only 32 % of ectopic liver cell carcinomas had a cirrhotic background (7), and two of 21 cases reported by Arakawa et al had positive viral serology (5), which suggests EL is of itself apt to undergo malignant transformation (6). The reasons for this greater degenerative ability remain unknown; however, deficient blood flow through the hepatic artery and an absent connection with the portal and biliary systems are thought to be triggering factors, possibly as a result of long-term exposure to carcinogenic substances (1,5,7).…”

Unresectable Ectopic Hepatocellular Carcinoma Treated with Sorafenib

“…Surgical resection of ectopic HCC is recommended, which is curative and has a favorable prognosis, because the carcinogenetic potential of these tumors is typically confined to the ectopic liver itself [7]. However, this may not apply to patients with persistent elevation of serum AFP or multiple unresectable ectopic HCC due to peritoneal dissemination [1,7,11], whose clinical presentations of advanced cancer were also seen in our case.…”

“…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].…”

Ectopic Hepatocellular Carcinoma

“…In rare cases, multiple brown nodules were found on the peritoneal surface and in the mesentery, sometimes associated with hemorrhagic ascites (Kawahara et al 1988;Miyake et al 2012).…”