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Sarma M, Padma S, Pavithran P, Somasundaram VH, Sundaram PS. Extrahepatic metastases of hepatocellular carcinoma on 18F FDG PET CT. J Egypt Natl Canc Inst 2021; 33:36. [PMID: 34825288 DOI: 10.1186/s43046-021-00086-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/19/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To determine locations, relative frequencies, imaging features, and pattern of distribution of extrahepatic metastasis from hepatocellular carcinoma (HCC) on 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) PET CT. METHODS FDG PET CT scans of 224 consecutive patients of HCC acquired between 2010 and 2018 were reviewed. Fifty-six patients detected with extrahepatic metastasis on FDG PET CT were retrospectively analyzed. Findings were correlated with prior/follow-up imaging studies, clinical findings, FNAC, or biopsy findings whenever available. Descriptive analysis of location, relative frequencies, imaging features, and pattern of distribution of extrahepatic metastasis was done. RESULTS Commonest were metastatic pulmonary nodules (55.3% patients), most of them being well-defined solid lesions (53.5%) with bilateral involvement in 44.6% patients and lower lobes of lungs along with other lobes being more frequently involved (41.0% patients). While in 7.14% patients lung nodules were FDG avid, 23.2% patients had both FDG avid and non-avid pulmonary nodules. Second most common were regional metastatic lymph nodes in 44.65% of patients seen at aortocaval (25%), paraaortic (23.21%), portocaval (21.4%), and left gastric nodal (17.8% of patients) stations. Twenty-five percent of patients had FDG avid lymph nodes and 5.36% patients had both FDG avid and FDG non-avid lymph nodes. Distant metastatic lymph nodes were third most common in 39.2% of patients seen at paratracheal (2.5%), juxtaphrenic (8.9%), and mesenteric lymphnodal (7.1%) stations. Twenty-five percent of patients had FDG avid lymph nodes while 5.36% patients had both FDG avid and FDG non-avid lymph nodes. Skeletal involvement was seen in 32.1% of patients. Commonest sites are vertebrae (16.7%), pelvis (14.2%), and ribs (10.7% patients). Six out of 7 patients had unilateral adrenal gland involvement. Bilateral adrenal gland involvement was seen in 1 patient. FDG non-avid peritoneal/omental metastases was seen in 2 patients. Brain, spleen, and muscle metastatic lesions were seen in 1 patient each out of 56 patients (1.79%). CONCLUSIONS Lungs, regional and distant lymph nodes and skeleton are the most frequently involved sites of extrahepatic metastatic hepatocellular carcinoma. Adrenal glands, muscles, brain and peritoneum are also involved but to a lesser extent.
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Affiliation(s)
- Manjit Sarma
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences, (Amrita Vishwa Vidyapeetham), Cochin, Kerala, 682041, India.
| | - Subramanyam Padma
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences, (Amrita Vishwa Vidyapeetham), Cochin, Kerala, 682041, India
| | - Parvathy Pavithran
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences, (Amrita Vishwa Vidyapeetham), Cochin, Kerala, 682041, India
| | - Vijay Harish Somasundaram
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences, (Amrita Vishwa Vidyapeetham), Cochin, Kerala, 682041, India
| | - Palanisamy Shanmuga Sundaram
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences, (Amrita Vishwa Vidyapeetham), Cochin, Kerala, 682041, India
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Abouzied MM, Alhinti N, AlMuhaideb A, Al Sugair AS, Al Qahtani M. Extrahepatic metastases from hepatocellular carcinoma: multimodality image evaluation. Nucl Med Commun 2021; 42:583-591. [PMID: 33625188 DOI: 10.1097/mnm.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most prevalent primary malignancy of the liver is hepatocellular carcinoma (HCC); its poor prognosis is mainly related to intrahepatic recurrence and extrahepatic metastases. However, survival from HCC has improved due to better control of the primary tumor, the development of newer treatment modalities, including liver transplant, together with advances in imaging techniques. Therefore, the significance of patient management as corresponds with distant metastases has increased; since the proper evaluation and detection of extrahepatic metastases is crucial to optimize potential therapy for patients. Conventional imaging like CT, MRI play crucial rule in patient's diagnosis and qualifying for a certain type of therapy. More recently, a molecular imaging tool with radiolabeled deoxyglucose and fluorocholine has proved its promising value as a complementary tool to conventional studies. In this review, the frequent sites of metastases and HCC spread are discussed as well as the imaging findings as seen by both conventional imaging techniques and by molecular imaging tools, namely 18F-Choline PET/CT, and FDG PET. The implications of guiding treatment planning have also been discussed.
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Affiliation(s)
| | - Nayef Alhinti
- Department of Radiology, King Faisal Specialist Hospital & Research Centre
| | - Ahmad AlMuhaideb
- Department of Radiology, King Faisal Specialist Hospital & Research Centre
| | | | - Mohammed Al Qahtani
- Cyclotron and Radiopharmaceuticals Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Large hepatocellular carcinoma in a non-cirrhotic liver with peritoneal and omental metastasis in a healthy man: a case report. J Med Case Rep 2017; 11:34. [PMID: 28173830 PMCID: PMC5297144 DOI: 10.1186/s13256-017-1203-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background Liver cancer is the second leading cause of cancer death in men worldwide. Hepatocellular carcinoma usually develops in the setting of cirrhosis or chronic inflammation. Major risk factors for developing hepatocellular carcinoma are chronic hepatitis B or C virus infection, alcoholic cirrhosis, and nonalcoholic fatty liver disease. The most frequent locations for hepatocellular carcinoma to metastasize are the lungs, portal vein, bones, and regional lymph nodes. Case presentation A 41-year-old Sri Lankan man presented with progressive abdominal distension and on examination was found to have a palpable irregular mass in the left lobe of his liver with moderate ascites. His ascitic fluid was an exudate without malignant cells. An ultrasound scan and contrast-enhanced computed tomography of his abdomen showed a large contrast-enhancing lesion in the left lobe of his liver without features of cirrhosis. Laparoscopic assessment revealed peritoneal and omental deposits. Histology of the biopsies taken from the liver lesion, omental deposits, and peritoneal deposits supported a diagnosis of hepatocellular carcinoma. His liver biochemistry was normal and hepatitis serology was negative. He is abstinent from alcohol and did not have metabolic syndrome. Conclusions It is rare for a young patient to develop hepatocellular carcinoma with a normal liver without chronic hepatitis B or C infection, or any other risk factors. Intraperitoneal metastasis of non-ruptured hepatocellular carcinoma is also very rare. Here we report a rare case of a 41-year-old man with a large hepatocellular carcinoma in a non-cirrhotic liver without chronic hepatitis who presented with peritoneal and omental metastasis.
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Sakoda M, Ueno S, Iino S, Hiwatashi K, Minami K, Kawasaki Y, Kurahara H, Mataki Y, Maemura K, Shinchi H, Natsugoe S. Survival Benefits of Small Anatomical Resection of the Liver for Patients with Hepatocellular Carcinoma and Impaired Liver Function, Based on New-Era Imaging Studies. J Cancer 2016; 7:1029-36. [PMID: 27326244 PMCID: PMC4911868 DOI: 10.7150/jca.15174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/26/2016] [Indexed: 12/20/2022] Open
Abstract
Background: It has been reported that anatomical resection of the liver may be preferred for primary hepatocellular carcinoma (HCC), and is at least recommended for systematic removal of a segment confined by tumor-bearing portal tributaries. However, nonanatomical resection (NAR) is often selected because of the patient's background, impairment of liver function, and tumor factors. The aims of the present study were to retrospectively compare the recurrence-free survival (RFS) rates for cases of partial resection (PR) and for small anatomical resection (SAR), which is regarded as NAR for primary HCC with impaired liver function. Patients and Methods: So-called NAR was performed for a primary and solitary (≤ 5cm) HCC in 47 patients; the patients were classified into PR (n=25) and SAR (n=22) groups. Clinicopathological factors, survival data, and recurrence patterns were compared between groups. Results: There were no significant differences in the preoperative characteristics between the two groups. Operative time was significantly longer in the SAR group than in the PR group. There was no significant difference in the postoperative morbidity and tumor pathological characteristics between the two groups. The RFS of the SAR group was significantly better than those of the PR group. Although there was no significant difference in the pattern of recurrence between the two groups, the rate of intrahepatic recurrence in the same segment as the initial tumor tended to be higher in the PR group than in the SAR group. Multivariate analysis revealed that only the PR operative procedure was significant independent risk factor for poorer RFS. Conclusion: Compared with PR, SAR effectively improves the rate of RFS after surgery for a primary and solitary HCC with impaired liver function.
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Affiliation(s)
- Masahiko Sakoda
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Shinichi Ueno
- 2. Department of Clinical Oncology, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Satoshi Iino
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Kiyokazu Hiwatashi
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Koji Minami
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Yota Kawasaki
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroshi Kurahara
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Yuko Mataki
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Kosei Maemura
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroyuki Shinchi
- 3. Kagoshima University Graduate School of Health Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Shoji Natsugoe
- 1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
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Becker AK, Tso DK, Harris AC, Malfair D, Chang SD. Extrahepatic metastases of hepatocellular carcinoma: A spectrum of imaging findings. Can Assoc Radiol J 2013; 65:60-6. [PMID: 24239313 DOI: 10.1016/j.carj.2013.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumour of the liver, responsible for significant morbidity and mortality worldwide. In the Western world, it primarily affects patients with cirrhosis, secondary to hepatitis C virus and alcoholism. In the rest of the world, HCC is closely associated with hepatitis B virus infections. Radiologists play a key role in accurately staging HCC, which has important implications for treatment planning. This pictorial review aims to describe the routes of HCC spread and the most frequent sites of metastases, to recognize extrahepatic HCC findings on computed tomography and magnetic resonance imaging, and to understand the implications of HCC staging on treatment planning.
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Affiliation(s)
- Annalisa K Becker
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver British Columbia, Canada.
| | - David K Tso
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver British Columbia, Canada
| | - Alison C Harris
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver British Columbia, Canada
| | - David Malfair
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver British Columbia, Canada
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver British Columbia, Canada
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Ueda J, Yoshida H, Mamada Y, Taniai N, Mineta S, Yoshioka M, Hirakata A, Kawano Y, Kanda T, Uchida E. Resection of hepatocellular carcinoma recurring in the diaphragm after right hepatic lobectomy. J NIPPON MED SCH 2011; 78:30-3. [PMID: 21389645 DOI: 10.1272/jnms.78.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe a 35-year-old man with hepatocellular carcinoma (HCC) that recurred in the diaphragm after right hepatic lobectomy. The patient had undergone right hepatic lobectomy for HCC with chronic hepatitis B virus infection 1 year previously. On pathological examination, the tumor measured 15 × 14.4 × 11 cm and was moderately well differentiated. The surgical margins were negative. After 1 year, computed tomography of the abdomen revealed a mass extending from the right side of the diaphragm to the retroperitoneal space. The mass was enhanced in the early phase and washed out in the late phase. Extrahepatic recurrence of HCC in the diaphragm was diagnosed. We performed tumor resection with partial resection of the right side of the diaphragm and wedge resection of the right lower lobe of the lung. The diaphragm was reconstructed with a sheet of artificial pericardium. The histopathological diagnosis was recurrence of HCC in the diaphragm with invasion of the right lung. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. He underwent chemotherapy with cisplatin and 5-fluorouracil. After 9 months, the patient died of unresectable recurrence of HCC in the brain. No recurrence was detected in the right subphrenic area.
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Affiliation(s)
- Junji Ueda
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Kim HC, Yang DM, Jin W, Park SJ. The various manifestations of ruptured hepatocellular carcinoma: CT imaging findings. ACTA ACUST UNITED AC 2009; 33:633-42. [PMID: 18172704 DOI: 10.1007/s00261-007-9353-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) has a tendency to rupture spontaneously which leads to a life-threatening condition. Disruption of the tumor surface or a tear in a parasitic feeding artery can cause HCC rupture leading to hemoperitoneum. When evaluating patients with a ruptured HCC, CT can detect tumors, determine tumor extent, define the presence of tumor bleeding, and show serial hematoma density changes. Thus, familiarity with the various CT findings of ruptured HCCs is essential to ensure proper diagnosis and treatment. In this pictorial essay, the authors illustrate the usual and unusual manifestations of ruptured HCCs, as visualized by CT, and include some angiographic correlations. CT findings predictive of HCC rupture are also discussed.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, East-West Neo Medical Center, Kyung-Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Republic of Korea.
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Clinical features of hepatocellular carcinoma developing extrahepatic recurrences after curative resection. World J Surg 2009; 32:1738-47. [PMID: 18463920 DOI: 10.1007/s00268-008-9613-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Few details of the clinical features of hepatocellular carcinoma (HCC) developing extrahepatic recurrence after a curative resection have been published. The purpose of this study was to clarify the clinicopathologic findings of patients with HCC who experienced extrahepatic metastases. METHODS Clinicopathologic data were available for 119 patients who underwent an R0 resection for HCC. Twenty-three patients who developed extrahepatic metastases during the follow-up period were compared with the patients who remained free from recurrence for at least 5 years after resection (n = 21) or with only intrahepatic recurrences (n = 75). RESULTS Patients with extrahepatic recurrences were more likely to have their tumor macro- or microscopically invading the tumor capsule (P < 0.001) and hepatic vein (P = 0.003), a high AFP concentration (P = 0.014), and advanced TNM stage (P = 0.006) than the other patients. As for treatment-related variables, inflow vessel occlusion during hepatectomy was less frequently associated with extrahepatic recurrences than if it were not performed (P < 0.001). By multivariate analysis, absence of tumor invasion to the capsule (relative risk [RR] = 0.080; P = 0.023) or to the hepatic vein (RR = 0.108; P = 0.014) and a hepatectomy in which inflow vessel occlusions were performed (RR = 0.161; P = 0.004) were selected as independent factors for reducing extrahepatic recurrences after a hepatectomy. CONCLUSION In HCC patients, the control of intrahepatic recurrences and extrahepatic recurrences after a hepatectomy is important to improve the prognosis. Inflow occlusion during the hepatectomy may reduce HCC metastases to extrahepatic sites.
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KIM HC, YANG DM, JIN W, KIM GY, CHOI SI. Metastasis to the appendix from a hepatocellular carcinoma manifesting as acute appendicitis: CT findings. Br J Radiol 2008; 81:e194-6. [PMID: 18559899 DOI: 10.1259/bjr/79390979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kim SR, Ikawa H, Ando K, Mita K, Fuki S, Imoto S, Shimizu K, Kanbara Y, Sugimoto K, Fujii M, Kudo M, Matsuoka T, Hayashi Y. Small hepatocellular carcinoma presenting with massive metastasis in the peritoneum, mimicking sarcomatous tumor. Hepatol Res 2007; 37:885-9. [PMID: 17573942 DOI: 10.1111/j.1872-034x.2007.00134.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The case of a 51-year-old man with hepatitis C virus (HCV)-related hepatocellular carcinoma metastasizing to the peritoneal cavity and mimicking a sarcomatous tumor is presented. A 12 x 12 cm mass, disclosed by computed tomography (CT), in the peritoneal cavity was predominantly isodense to muscle but had hypodense areas that suggested necrosis. T1-weighted magnetic resonance imaging (MRI) showed a large mass, slightly hyperintense to muscle, with local hyperintense areas of suspected hemorrhagic necrosis.T2-weighted MRI of the same region revealed a markedly non-homogeneous and hyperintense mass with inner high signals and peripheral brush-like linear striations. From such imaging studies, sarcomatous tumors, such as fibrosarcoma, leiomyosarcoma, and gastrointestinal stromal tumors, can be distinguished. Pathological findings at autopsy revealed necrotic tissue with a small portion of moderately differentiated HCC. Further studies may provide insights into the metastatic modes of HCC.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan
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Uka K, Aikata H, Takaki S, Shirakawa H, Jeong SC, Yamashina K, Hiramatsu A, Kodama H, Takahashi S, Chayama K. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol 2007; 13:414-20. [PMID: 17230611 PMCID: PMC4065897 DOI: 10.3748/wjg.v13.i3.414] [Citation(s) in RCA: 334] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients.
METHODS: After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies.
RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure.
CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatic tumor stage (T0-T2), and are free of portal venous invasion may improve survival.
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Affiliation(s)
- Kiminori Uka
- Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Lin CC, Chen CH, Tsang YM, Jan IS, Sheu JC. Diffuse intraperitoneal metastasis after spontaneous rupture of hepatocellular carcinoma. J Formos Med Assoc 2006; 105:577-82. [PMID: 16877238 DOI: 10.1016/s0929-6646(09)60153-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rupture of hepatocellular carcinoma (HCC) is a fatal complication. Intraperitoneal metastasis after rupture of HCC is rare. We report a case of diffuse intraperitoneal metastases after rupture of HCC. A previously asymptomatic 32-year-old man was admitted because of massive ascites due to ruptured HCC. Poor liver reserve limited the therapeutic options. Transarterial chemoembolization was performed to stop tumor bleeding. Abdominal computed tomography demonstrated multiple large peritoneal metastases 3 months after the rupture episode. Echo-guided fine needle aspiration from the suprapubic area was performed. Cytology was positive for HCC. It is rare for HCC to develop intraperitoneal metastases in as short as 3 months.
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Affiliation(s)
- Chien-Chu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Yeh CN, Chen MF, Jeng LB. Resection of peritoneal implantation from hepatocellular carcinoma. Ann Surg Oncol 2002; 9:863-8. [PMID: 12417507 DOI: 10.1007/bf02557522] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peritoneal implantation is a rare presentation of hepatocellular carcinoma (HCC). This article presents the clinical features and surgical outcomes of 16 patients with HCC in whom isolated peritoneal implantation from HCC was found and who underwent surgical resection. METHODS From 1988 to 2000, 16 patients with HCC after hepatic resection who underwent resection of peritoneal implantation of HCC were retrospectively reviewed. RESULTS Four hundred sixty-five of 749 patients (62.1%) had recurrence of HCC after hepatic resection. Sixteen (3.4%) developed isolated peritoneal implantation and underwent resection. During the detection of the peritoneal implantation, the alfa fetoprotein level was increased in 13 of these 16 patients. Five of 15 patients had a peritoneal mass discovered by ultrasonography, and 14 of 15 patients had a mass discovered by computed tomography. The follow-up period ranged from 2.1 to 81.6 months (median, 16 months). The median disease-free and overall survivals of the 16 patients were 7.89 and 15.98 months, respectively. CONCLUSIONS Peritoneal implantation occurs infrequently in posthepatectomy patients. Increased alfa fetoprotein values after hepatic resection should suggest recurrence of HCC. Computed tomography is superior to ultrasonography in detection of peritoneal implantation from HCC. Surgical resection of peritoneal implantation from HCC might prolong survival in selected patients.
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Affiliation(s)
- Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Katyal S, Oliver JH, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma. Radiology 2000; 216:698-703. [PMID: 10966697 DOI: 10.1148/radiology.216.3.r00se24698] [Citation(s) in RCA: 513] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine the relative frequency, incidence, and locations of metastases of hepatocellular carcinoma (HCC), correlate extrahepatic metastatic disease with intrahepatic tumor staging, and determine the computed tomographic (CT) manifestations of HCC metastases. MATERIALS AND METHODS CT findings in 403 consecutive patients with HCC at our institution since 1992 were reviewed retrospectively. One hundred forty-eight patients with extrahepatic metastatic HCC were identified, and the locations, sizes, and attenuation and enhancement characteristics of the lesions were recorded. RESULTS A majority (128 [86%] of 148) of patients with extrahepatic HCC foci had either intrahepatic stage IVA tumor (112 [76%] patients) or an intrahepatic stage III tumor (16 [11%] patients) at the occurrence of metastases. The most frequent site of the first detectable metastasis was the lung (58 [39%] patients). Tabulation of all extrahepatic metastatic sites showed the most common to be the lung in 81 (55%) patients, the abdominal lymph nodes in 60 (41%) patients, and the bone in 41 (28%) patients. CONCLUSION The lung, abdominal lymph nodes, and bone are the most common sites of extrahepatic metastatic HCC. Most extrahepatic HCC occurs in patients with advanced intrahepatic tumor stage (stage IVA). Incidental extrahepatic lesions at CT in patients with stage I or II intrahepatic HCC are unlikely to represent metastatic HCC.
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Affiliation(s)
- S Katyal
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA.
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Kim TK, Han JK, Chung JW, Choi BI, Park JH, Han MC. Intraperitoneal drop metastases from hepatocellular carcinoma: CT and angiographic findings. J Comput Assist Tomogr 1996; 20:638-42. [PMID: 8708071 DOI: 10.1097/00004728-199607000-00026] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Our goal was to describe the radiological manifestations of intraperitoneal drop metastases (IPDMs) from hepatocellular carcinoma (HCC). METHODS Seven patients with clinically (n = 4) or pathologically (n = 3) proven IPDMs from HCC were retrospectively analyzed. Medical records, CT scans (n = 7), and angiographic findings (n = 5) were reviewed. RESULTS On CT scans, all seven patients had single or multiple nodular masses in the liver. In six patients, the hepatic masses showed an exophytic growth. Single (n = 4) or multiple (n = 3) discrete omental masses, 3-10 cm in diameter, were also demonstrated in all patients. Intratumoral necrosis in the omental mass and engorgement of adjacent omental vessels were demonstrated in five and three patients, respectively. On angiography, the omental masses showed hypervascularity supplied by omental branches (n = 4) and superior mesenteric (n = 2) and inferior mesenteric (n = 1) artery and also showed prominent draining veins. CONCLUSION The radiological manifestations of IPDM from HCC are single or multiple discrete hypervascular masses in the omentum. These are quite different from those of usually carcinomatosis peritonei.
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Affiliation(s)
- T K Kim
- Department of Diagnostic Radiology, Seoul National University Hospital, Korea
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