Ann Hepatobiliary Pancreat Surg.  2019 Feb;23(1):77-79. 10.14701/ahbps.2019.23.1.77.

Hemorrhagic extrahepatic recurrence of hepatocellular carcinoma: A case report

• Yeow GP
• Yeow DG
• Sankaran P
• Maiyauen T
• Sharif MS

• KMID: 2439051
• DOI: http://doi.org/10.14701/ahbps.2019.23.1.77

Abstract

The recurrence of hepatocellular carcinoma (HCC) can mainly be divided into two phases or types: the intrahepatic recurrence (IHR) and the extrahepatic recurrence (EHR). Generally speaking, the EHR is usually referenced as being the less common of the two types or categories. In a post-hemihepatectomy patient with routine surveillance at 6 months, it was noted that the patient appeared to have an elevated alpha-fetoprotein, and also complained of vague lower abdominal pain. The accompanying computed tomography scan revealed a 6 cm-sized heterogeneous mass located at the pelvis region. Next, during a laparotomy for resection, the tumor was found to be bleeding from the omental deposition. In conclusion, a high index of suspicion and early surgical intervention can help in detecting possible bleeding extrahepatic recurrence in the background of a patient with history of HCC.

Keyword

Hepatocellular carcinoma; Omental recurrence; Recurrence; Extrahepatic

MeSH Terms

Abdominal Pain
alpha-Fetoproteins
Carcinoma, Hepatocellular*
Hemorrhage
Humans
Laparotomy
Pelvis
Recurrence*
alpha-Fetoproteins

Reference

1. Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010; 4:439–474. PMID: 20827404.

2. Kudo M, Okanoue T. Japan Society of Hepatology. Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology. Oncology. 2007; 72(Suppl 1):2–15.

3. Liu CL, Fan ST, Lo CM, Tso WK, Poon RT, Lam CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol. 2001; 19:3725–3732. PMID: 11533094.

4. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg. 2006; 141:191–198. PMID: 16490898.

5. Yang Y, Nagano H, Ota H, Morimoto O, Nakamura M, Wada H, et al. Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery. 2007; 141:196–202. PMID: 17263976.

6. Terada T, Takeuchi T, Hirano R, Nagata S, Kubota H, Honda S. Spontaneous rupture of peripancreatic lymph node with hepatocellular carcinoma metastasis: report of an autopsy case with massive peritoneal bleeding. Hepatol Res. 2003; 26:73–76. PMID: 12787808.

7. Chen HW, Yang CF, Chao CC. Spontaneous rupture of peritoneal seeding hepatocellular carcinoma: report of two cases. J Acute Med. 2016; 6:64–66.

8. Hong SS, Kim TK, Sung KB, Kim PN, Ha HK, Kim AY, et al. Extrahepatic spread of hepatocellular carcinoma: a pictorial review. Eur Radiol. 2003; 13:874–882. PMID: 12664129.