[A Case of Hepatocellular Carcinoma with Iatrogenic Recurrence in Peripancreatic Lymph Nodes]

The patient presented with a 38 mm-sized mass in the S3/4 of the liver on contrast-enhanced CT in his seventies. He underwent hepatic left lobectomy and cholecystectomy as hepatocellular carcinoma. Postoperative histopathology revealed a diagnosis of intermediate differentiated hepatocellular carcinoma, pT3, pN0, pM0, pStage Ⅲ. Ten months after surgery, a contrast-enhanced CT scan of the abdomen showed a recurrence in the caudate lobe, and a partial caudate lobe resection was performed. Nine months after reoperation, a peripancreatic lymph node recurrence was noted, and a lymphadenectomy was performed. Six months later, metastasis was detected in S3 of the right lung, and the patient was started on atezolizumab+bevacizumab therapy for 15 months. Five years and 2 months after the initial surgery, Abdominal CT showed enlarged peripancreatic lymph nodes and an elevated lesion in the duodenal bulb. The bulky lesion in the duodenum was diagnosed as recurrence of hepatocellular carcinoma. The raised lesion in the duodenum was diagnosed as recurrence of hepatocellular carcinoma on biopsy. Currently, drug therapy is being resumed.