Subcutaneous seeding of small hepatocellular carcinoma after fine needle aspiration biopsy

Abstract

Ultrasonically guided fine needle (21 gauge) aspiration biopsy (FNAB) was performed on a patient with a hepatocellular carcinoma (HCC) measuring 1.5 x 1.5 cm in segment VI of the liver. The tumour was located just beneath the liver surface. Subsegmentectomy of segment VI was performed. Twelve months after the biopsy and 10 months after the operation, levels of alpha-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist-II (PIVKA-II) increased gradually without any evidence of recurrence of HCC in the liver. Thirteen months after the biopsy, the patient palpated a hard subcutaneous nodule 1.5 cm in diameter in the right lower anterior chest wall at the insertion site of the biopsy needle. A subcutaneous tumour was excised and histological examination revealed moderately differentiated HCC. The levels of AFP and PIVKA-II normalized thereafter. These tumour markers were therefore useful for diagnosing the subcutaneous nodule as a metastatic HCC. The patient is currently doing well without further recurrence of HCC or needle-tract seeding 23 months after subsegmentectomy and 11 months after excision of the subcutaneous tumour.

Needle tract seeding: An avoidable complication

“…5,6 Subcapsular location of the tumor, high grade HCC with poor differentiation, elevated levels of serum Alpha Feto Protein (AFP), tumor size more than 2cm in diameter, multiple RFA sessions, patient immunosuppression and previous history of biopsy have been identified as possible risk factors for needle tract seeding in HCC.…”

Successful Treatment of Dissemination of Hepatocellular Carcinoma to the Pleura and Diaphragm after Percutaneous Liver Biopsy

“…Thus, wide resection including soft tissue and bone should be recommended for implanted tumors. In fact, aggressive surgical resection has enabled successful local control in some patients [8, 9]. In our patient, multiple tumors were present on the pleura and diaphragm.…”

“…Usually implantation of hepatocellular carcinoma is found in the abdominal wall or the chest wall including intercostal muscle and subcutaneous tissue, and tumor cells also invade vessels including the lymph ducts in the chest wall [8, 9, 13]. The key to successful treatment of primary chest wall malignancies is still early diagnosis and aggressive surgical resection [14].…”

“…There have been few reports of successful treatment of implanted tumor(s) [5, 7, 8, 9, 10, 11]. In addition, dissemination of hepatocellular carcinoma in the pleural cavity and diaphragm by needle biopsy is rare [11].…”

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“…12 Although pretransplant biopsy procedures are widely performed and are defined as a safe and noninvasive method, there are several publications that the procedure has the risk of seeding and peritoneal dissemination. [13][14][15][16] A biopsy has risks, including bleeding and abdominal dissemination. To determine whether preoperative fine needle aspiration (FNA) biopsy was related to tumor recurrence, one study divided patients with HCC into 2 groups: HCC patients without FNA biopsy and HCC patients with preoperative FNA biopsy.…”