Surgical therapy in two patients with pedunculated hepatocellular carcinoma

Hepatocellular carcinoma (HCC) occurring as an appendage from the main hepatic parenchyma is a rare entity, of which two cases are herein described. Because proper surgical management of this tumor (pedunculated HCC) is unclear, the world's literature was reviewed to determine optimal therapy. Thirty-four cases were documented, including the two cases reported herein. Diagnosis was usually obscure, despite modern invasive and noninvasive methods, and laparotomy or autopsy were required for specific identification of tumor type. Sixteen resections were reported among 18 explorations. One patient had transarterial embolization. Fifteen received medical therapy only. Surgically treated patients usually died of metastatic disease, whereas most medically treated patients died of gastrointestinal or tumor hemorrhage. Pedunculated HCC may be more amenable to curative resection than ordinary HCC due to its unique localization and growth pattern.