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Published on: March 10, 2023
Successful surgical control of peritoneal dissemination of hepatocellular carcinoma
Norio Yokoigawa1, Tokuhiro Ogura, A-H Kwon
1Department of Surgery, Kansai Medical University, Moriguchi, Japan.
Insights
This case study presents a rare instance of well-differentiated hepatocellular carcinoma (HCC) with extensive peritoneal dissemination. Surgical intervention, while not curative, offered potential survival benefits and improved quality of life for this patient.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Peritoneal dissemination of hepatocellular carcinoma (HCC) lacks established treatment protocols.
- HCC typically spreads via vascular or lymphatic routes, with intraperitoneal spread being uncommon.
Observation:
- A 74-year-old male presented with multiple intra-abdominal tumors, including a left hepatic lobe mass, diaphragmatic, splenic, and pelvic masses.
- Laparotomy revealed widely separated tumors, confirmed histopathologically as well-differentiated HCC.
- The patient underwent extensive surgical resection including partial hepatectomy and removal of all disseminated tumors.
Findings:
- This case represents a rare occurrence of well-differentiated HCC with extensive intraperitoneal metastasis.
- Surgical resection was technically feasible for all identified tumor sites.
- Histopathology confirmed all resected lesions as well-differentiated HCC, contradicting typical patterns of undifferentiated tumors in peritoneal spread.
Implications:
- This case highlights the possibility of well-differentiated HCC disseminating intraperitoneally, challenging current understanding.
- While not curative, aggressive surgical management may be a viable option for selected patients with peritoneal HCC.
- Further research is warranted to explore optimal treatment strategies for this rare presentation of HCC.
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.
