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Case Reports
. 2012 Sep;6(3):612-7.
doi: 10.1159/000343248. Epub 2012 Sep 26.

Successful surgical control of peritoneal dissemination of hepatocellular carcinoma

Norio Yokoigawa  1 , Tokuhiro Ogura, A-H Kwon
Affiliations
Case Reports

Successful surgical control of peritoneal dissemination of hepatocellular carcinoma

Norio Yokoigawa et al. Case Rep Gastroenterol. 2012 Sep.

Abstract

Treatment for the peritoneal dissemination of hepatocellular carcinoma (HCC) has not yet been established. We report a patient with HCC associated with disseminated intra-abdominal tumor. A 74-year-old man was admitted to our hospital. Computed tomography showed a 3 × 3 cm mass in the left hepatic lobe and a giant mass between the stomach and spleen. At laparotomy, the tumor was seen in the medial segment and evaginated to the diaphragm. There was a tumor between the stomach and spleen, confirmed as a 5 × 5 cm tumor evaginated from the left diaphragm, and a 7 × 7 cm tumor adhesive to the spleen. These two tumors were not continuous and were separated. Furthermore, we confirmed a 10 × 10 cm tumor in the pelvic cavity. We performed partial hepatectomy, resection of the tumor evaginated from the diaphragm, resection of the tumor of the spleen and tail of pancreas, and resection of the tumor in the pelvic cavity. Histopathologically, all resected tumors were confirmed to be well-differentiated HCC. HCC rarely disseminates intraperitoneally. It is considered that the peritoneal dissemination of HCC occurred from poorly differentiated or undifferentiated type. Then this report is a rare case. Although surgical treatment of peritoneal dissemination of HCC is not curative, surgery may improve survival and provide good quality of life in selected cases.

Keywords: Hepatocellular carcinoma; Peritoneal dissemination; Surgical control.

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Figures

Fig. 1
Fig. 1
Ultrasonography showed a well-defined 3.5 × 2.6 cm high-echoic mass in the medial segment of the liver.
Fig. 2
Fig. 2
Enhanced computed tomography revealed a low-density area in the medial segment of the liver (a; arrow) and a giant mass continuing from the diaphragm to the left kidney between the stomach and spleen (a, b; arrowhead).
Fig. 3
Fig. 3
a–d Surgical specimens. All specimens were solid and of well-defined shape. a Tumor of the liver. b Tumor of the diaphragm. c Tumor of the omentum. d Tumor of the hilum of the spleen. e–h Histopathologic examination of all resected specimens revealed well-differentiated HCC and steatosis (hematoxylin and eosin, ×200). e Tumor of the liver. f Tumor of the diaphragm. g Tumor of the omentum. h Tumor of the hilum of the spleen.
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