Laparoscopic resection of HCC implanted in the peritoneal cavity: a case detected by PET after hepatic resection

Intra-peritoneal implantation of hepatocellular carcinoma (HCC) after hepatic resection can occur in rare cases. Laparoscopic surgery is being rapidly adopted as a minimally invasive surgical technique for the treatment of HCC. Positron emission tomography with 18F-fluorodeoxyglucose can detect tumor by way of estimating the glucose metabolism of the tumor cells. We experienced a case of intra-peritoneal implantation of HCC that was depicted only by positron emission tomography and then treated by laparoscopic surgery. A 36-year-old male patient had undergone hepatic resection for HCC. In the course of the postoperative follow-up, the alpha-fetoprotein level had gradually risen. The positron emission tomography depicted a small tumor in the peritoneal cavity anterior to the spleen even though abdominal sonography, CT and celiac angiography had failed to detect it. The tumor was resected using laparoscopy, and it was revealed as HCC. Until now, no evidence of recurrence has been found for 3 years since the laparoscopic surgery. Intra-peritoneal implantation of HCC can be treated successfully with laparoscopic surgery, a minimally invasive surgery, in those selected cases such as with solitary HCC implantation.