Hepatocellular Carcinoma Recurrence with Metachronous Peritoneal Metastasis - A Controversial Surgical Indication

Simões João,Tralhão José Guilherme,Amaral Maria João,Serôdio Marco

doi:10.36959/879/381

Abstract

We present the case of a female patient who underwent surgery for a big hepatic adenoma that suffered malignant transformation. Fifteen months later, she had HCC liver recurrence with peritoneal metastases, being submitted to a new surgery with complete resection of the hepatic mass and peritoneal implants.

Highlights

Hepatocellular carcinoma (HCC) is the fifth most common solid tumor worldwide and the most common primary liver cancer, with incidence increase in developed countries [1,2]
We present a case report of a female patient that underwent surgery for a growing hepatic adenoma
Surgery could be a good approach to localized peritoneal metastasis of HCC in patients with a controlled primary disease and may improve survival in selected patients, in the absence of other extrahepatic metastases and who are suitable for radical treatment

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common solid tumor worldwide and the most common primary liver cancer, with incidence increase in developed countries [1,2]. A 41-year-old caucasian female patient was diagnosed with a 4 cm hepatic solid mass on her left liver, consistent with an adenoma, in a routine abdominal ultrasound She had a past medical history of irritable bowel syndrome and asthma. A new HMRI showed a 17 mm mass in the left liver, near the hepatic resection parenchyma, with T2 hypersignal (Figure 1), without evidence of enhancement after contrast and without restriction diffusion-weighted images (Figure 2). After a new case discussion at a MHBPM, with the presumptive diagnosis of peritoneal relapse and a liver nodule of unknown etiology, the patient underwent an exploratory laparoscopy that revealed the already known solid nodule on Morison’s space and on the great omentum, and a solid mass on the left hepatic lobe, near the previously resected area. On the MHBPM, adjuvant treatment with sorafenib was proposed, 400 mg bid, which the patient accepted

Discussion

Findings

Conclusion