Korean J Hepatobiliary Pancreat Surg.  2014 May;18(2):56-59. 10.14701/kjhbps.2014.18.2.56.

Giant pedunculated hepatocellular carcinoma masquerading as a pelvic mass: a case report

Affiliations
  • 1Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. gs2834@schmc.ac.kr

Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, with high frequency rates in Asia. Many of the patients have unresectable disease at the time of diagnosis, and early detection and surgical resection is the best hope for survival. But, if HCC is presenting as an extrahepatic mass, the diagnosis is difficult. Herein, we report a case of primary HCC masquerading as a pelvic mass. A 74-year-old woman was admitted to our hospital due to a palpable mass in the lower abdomen. CT scan detected an approximately 15.0x13.4x11.4 cm-sized multilobulated homogeneous enhancing mass in the right adnexa. Operative findings showed that the pelvic mass originated from the liver. We performed hepatic wedge resection. Permanent histopathologic report revealed primary HCC. Exophytic-growing hepatocellular carcinoma should be carefully diagnosed.

Keyword

Hepatocellular carcinoma; Pelvis; Giant mass

MeSH Terms

Abdomen
Aged
Asia
Carcinoma, Hepatocellular*
Diagnosis
Female
Hope
Humans
Liver
Pelvis
Tomography, X-Ray Computed

Figure

  • Fig. 1 Computed tomography findings showing multilobulated homogeneous enhancing mass in the right adnexa with multiple low density foci and tubular intense enhancing structure (A and B).

  • Fig. 2 Operative findings showing a huge mass with a thin peduncle which was originated from the left lateral hepatic lobe (A and B).

  • Fig. 3 Gross and microscopic findings showing a pedunculated hepatic mass (A) and a microphotopraph representing hepatocellular carcinoma (HE ×200) (B).


Reference

1. National Cancer Center. Korean national cancer registry annual report. http://www.ncc.re.kr.
2. Horie Y, Katoh S, Yoshida H, Imaoka T, Suou T, Hirayama C. Pedunculated hepatocellular carcinoma. Report of three cases and review of literature. Cancer. 1983; 51:746–751. PMID: 6295613.
Article
3. Yan ML, Wang YD, Lai ZD, Tian YF, Chen HB, Qiu FN, et al. Pedunculated hepatocellular carcinoma and splenic metastasis. World J Gastroenterol. 2009; 15:5239–5241. PMID: 19891029.
4. Kurachi K, Suzuki S, Yokoi Y, Okumura T, Inaba K, Igarashi T, et al. A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma. J Gastroenterol. 2002; 37:571–574. PMID: 12162418.
Article
5. Okuda K, Arakawa M, Kubo Y, Sakata K, Kage M, Iwamoto S, et al. Right-sided pedunculated hepatocellular carcinoma: a form of adrenal metastasis. Hepatology. 1998; 27:81–85. PMID: 9425921.
Article
6. Eggel H. Über das primäre Carcinom der Leber. Beitr. Pathol Anat Allg Pathol. 1901; 30:506–604.
7. Roux C. Un cas de cancer primitif du foie avec pericholecystite calculeuse, perforation intestinale: hemostase hepatique. Rev Med Suisse Romande. 1897; 17:114–119.
8. Goldberg S, Wallerstein H. Primary massive liver cell carcinoma. Rev Gastroenterol. 1934; 1:305–313.
9. Yeh CN, Lee WC, Jeng LB, Chen MF. Pedunculated hepatocellular carcinoma: clinicopathologic study of 18 surgically resected cases. World J Surg. 2002; 26:1133–1138. PMID: 12209243.
Article
10. Tzouliadis L, Hulin SJ, Shaw I, Rees M. Image of the month--pedunculated hepatocellular carcinoma. Arch Surg. 2007; 142:95. PMID: 17224508.
11. Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K, et al. Pathology of hepatocellular carcinoma in Japan. 232 Consecutive cases autopsied in ten years. Cancer. 1983; 51:863–877. PMID: 6295617.
Article
12. Omanik S, Jablonsky I. Pedunculated accessory hepatic lobe. Arch Surg. 1972; 105:792–794. PMID: 5081554.
Article
13. Yeh CN, Lee WC, Jeng LB, Chen MF. Pedunculated hepatocellular carcinoma: clinicopathologic study of 18 surgically resected cases. World J Surg. 2002; 26:1133–1138. PMID: 12209243.
Article
14. Kim KW, Auh YH, Chi HS, Lee SI. CT of retroperitoneal extension of hepatoma mimicking adrenal tumor. J Comput Assist Tomogr. 1993; 17:599–602. PMID: 8392525.
Article
15. Kim HJ, Lee DH, Lim JW, Ko YT, Kim KW. Exophytic benign and malignant hepatic tumors: CT imaging Features. Korean J Radiol. 2008; 9:67–75. PMID: 18253078.
Article
16. Hashimoto M, Degawa H, Sakamoto M. A case of extrahepatic growing hepatocellular carcinoma. Gastroenterol Surg. 1989; 12:1473–1477.
17. Cunningham PL, Nava H, Lopez C, Douglass HO Jr. Pedunculated primary hepatocellular carcinoma. J Surg Oncol. 1984; 27:260–267. PMID: 6094924.
Article
18. Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg. 1996; 83:1219–1222. PMID: 8983610.
Article
19. Horie Y, Shigoku A, Tanaka H, Tomie Y, Maeda N, Hoshino U, et al. Prognosis for pedunculated hepatocellular carcinoma. Oncology. 1999; 57:23–28. PMID: 10394121.
Article
20. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954; 7:462–503. PMID: 13160935.
Full Text Links
  • KJHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr