Positron emission tomography/computer tomography in guidance of extrahepatic hepatocellular carcinoma metastasis management

Abstract

Hepatocellular carcinoma (HCC) is one of the most common primary cancers in the world. Surgery is the gold standard for treatment of patients with HCC. Recurrence and metastasis are the major obstacles to further improve the prognosis of HCC. Most recurrences are intrahepatic. However, 30% of the recurrences are extrahepatic. The role of resection in intrahepatic recurrences is widely accepted. The role of resection in extrahepatic HCC recurrence and metastasis is not well established. 18F fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) is useful in detecting distant metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in identification of intrahepatic and extrahepatic metastasis. We present one patient with one new isolated omental lymph node metastasis, who had a history of huge HCC resected six years ago. The metastatic focus was identified with 18 F-FDG PET/CT and resected. The follow-up revealed good prognosis with a long-term survival potential after resection of the omental lymphatic metastasis.

Figure 1

Contrast CT demonstrating a huge lesion at the left lobe of liver (black arrows, portal phase).

Figure 2

Whole body PET showing an isolated highly metabolic focus in the upper abdomen (white arrow) (A), non-enhanced CT (C) detecting a median density lesion in the omenta (white arrow), ¹⁸F-FDG PET (B) and fused imaging of PET/CT (D) revealing a highly metabolic lesion at the same position.