A case ectopic hepatocellular carcinoma with peritoneal dissemination

Abstract

An 83-year-old man was admitted to our hospital for further investigation of liver dysfunction. Laboratory examination revealed serum alpha-fetoprotein (AFP) levels of 4205ng/m/, an AFP/AFP-L3 ratio of 32.3%, an indocyanine green retention rate at 15 minutes of 25.9%, and negative serology for viral hepatitis. Ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging revealed an early enhanced tumor measuring approximately 3cm at its maximal dimension. The tumor contacted segment 6 of the liver, and there was no other specific space-occupying lesion in the liver. Detailed angiography revealed that the tumor received its blood supply from the gastroduodenal artery. A diagnosis of ectopic hepatocellular carcinoma was made and laparoscopy with partial liver resection was performed. Intraoperative findings revealed a small amount of bloody ascites and peritoneal dissemination. The tumor, which was attached to the liver, was resected. Histopathologically, the tumor was a moderately differentiated hepatocellular carcinoma without connection to the liver parenchyma. A final diagnosis of ectopic hepatocellular carcinoma accompanied by peritoneal dissemination was thus confirmed.