• bulky tumor
• hepatocellular carcinoma
• interstitial brachytherapy
• muscle metastasis
• radiotherapy

• contrast-enhanced ultrasonography
• hepatocellular carcinoma
• moderately differentiated
• muscular metastasis
• teres major muscle

• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media
• Humans
• Image Enhancement
• Liver Neoplasms/diagnostic imaging
• Male
• Ultrasonography

• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Choline/analogs & derivatives
• Humans
• Liver Neoplasms/diagnostic imaging
• Male
• Muscle, Skeletal/diagnostic imaging
• Neoplasm Recurrence, Local
• Positron Emission Tomography Computed Tomography
• Positron-Emission Tomography
• Prostatic Neoplasms
• Radiopharmaceuticals

• PIVKA-II
• anticoagulants
• canine
• poisoning

Solitary muscle metastasis of hepatocellular carcinoma (HCC) is extremely rare, and late metastasis is also rare. We present a 59-year-old man who had received initial treatment for HCC 13 years previously. Ultrasonography revealed a tumor between the abdominal wall and the liver surface. Tumor resection was performed with suspected intrahepatic metastasis or abdominal wall metastasis of HCC, and the tumor was found to be within the rectus abdominis without an association with the liver. Histologically, the resected material was confirmed to be a muscle metastasis of HCC. We discuss the management of muscle metastasis of HCC.

In 2018, Hepatocellular carcinoma (HCC) was predicted to be the sixth most commonly diagnosed cancer. Extra-hepatic metastasis due to HCC is a poor prognostic factor, depending on the stage of the disease.

We report a case of a 52-years old male who had undergone Segment 5 (S5) hepatectomy for HCC of 4.7 × 2 cm. Transcatheter arterial chemoembolization (TACE) four times postoperatively was performed based on a preoperative diagnosis of a recurrent tumour at the S1. After 2 years, the solitary tumour (7.5 × 2.5 × 3.5 cm) is located behind the right lobe of the liver and the head of the pancreas. The tumour was abnormally supplied with blood from the superior mesenteric artery (SMA) and the gastroduodenal artery (GDA). The patient was underwent pancreaticoduodenectomy (PD) to remove a large tumour. Postoperative pathology and immunohistochemical staining showed metastatic HCC. There was no tumour recurrence after 6 months.

The organs in the body that liver cancer cells most often spread to are the lungs (44%), the portal vein (35%), the hepatobiliary ganglion (27%), and a small number of cases of bone, eye socket, bronchus metastases. Otherwise, recurrence of lymph nodes (LNs) after hepatectomy for HCC is very rare.

HCC can metastasize to the hepatic pedicle LN after hepatectomy and maybe confused with recurrent liver tumours in the S1. Indications for PD are feasible for solitary metastatic at peri-pancreas. Pathology incorporating immunohistochemistry can determine the origin of metastases.

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Recurrence of lymph nodes after hepatectomy due to HCC is very rare at only approximately 1% to 2.5%.

• Case report
• Hepatocellular carcinoma
• Liver resection
• Lymph node
• Metastasis
• Pancreatic head
• Pancreaticoduodenectomy

Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) is associated with poor outcomes. However, the clinical features and risk factors of EHM of HCC after radiofrequency ablation (RFA) remain unclear.

To elucidate the characteristics and risk factors of EHM after RFA for HCC.

From January 2008 to December 2017, we retrospectively enrolled 661 patients who underwent RFA as first-line treatment for HCC at 2 tertiary hospitals. The inclusion criteria were age ≥ 18 years, a diagnosis of HCC, and treatment-naivety. Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) and alpha-fetoprotein measurements were routinely performed at 1 mo after RFA and followed-up at intervals of 3-6 mo. Univariate analyses were performed using the chi-squared test or Student’s t-test, and univariate and multivariate analyses were performed via logistic regression, as appropriate.

EHM was diagnosed in 44 patients (6.7%) during a median follow-up period of 1204 days. The 10-year cumulative rate of HCC recurrence and EHM was 92.7% and 33.7%, respectively. Initial recurrence was most often intrahepatic, and the rate of extrahepatic recurrence at initial recurrence was only 1.2%. The median time to the diagnosis of EHM was 2.68 years, and 68.2% of patients developed EHM within 2 years of the first recurrence, regardless of recurrence-free survival and 75.0% of patients developed EHM within 5 years after first recurrence. EHM was mostly diagnosed via abdominal CT/MRI in 33 (75.0%) and 38 of 44 patients (86.4%) with EHM had either positive abdominal CT scan results or serum AFP level elevation. In multivariate analysis, recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL were associated with a high EHM risk.

EHM occurs following multiple intrahepatic recurrences after RFA and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance. Patients especially with high-risk factors require close follow-up for EHM.

• Hepatocellular carcinoma
• Metastasis
• Radiofrequency ablation
• Surveillance
• Risk factor

• Adolescent
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/adverse effects
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local/epidemiology
• Radiofrequency Ablation/adverse effects
• Retrospective Studies
• Treatment Outcome

• PIVKA II
• hepatocellular carcinoma
• nomogram
• rare metastasis
• surgery
• systemic treatment