Abstract
IntroductionTumor rupture and pulmonary metastasis in patients with hepatocellular carcinoma are both associated with poor prognosis and treatment strategies are controversial.Case presentationHere we report a 50-year-old man with survival of over 90 months after undergoing an extended right lobectomy for a ruptured hepatocellular carcinoma and then repeated resections for pulmonary metastasis during the followup period.ConclusionThis case report shows that surgical resection can be an effective treatment for patients with both ruptured hepatocellular carcinoma and pulmonary recurrences.
Highlights
Tumor rupture and pulmonary metastasis in patients with hepatocellular carcinoma are both associated with poor prognosis and treatment strategies are controversial.Case presentation: Here we report a 50-year-old man with survival of over 90 months after undergoing an extended right lobectomy for a ruptured hepatocellular carcinoma and repeated resections for pulmonary metastasis during the followup period
The overall incidence of spontaneous rupture of Hepatocellular carcinoma (HCC) varies from 5% to 26%, with a mortality rate of up to 67%, especially in patients with poor liver function [1,2,3,4]
The patient presented with mild hemoptysis 30 months after the hepatectomy, and follow-up chest computed tomography (CT) demonstrated a metastasis in the right lower lobe the of lungs
Summary
Hepatocellular carcinoma (HCC) is the most common primary hepatic tumor and one of the most common cancers worldwide. Some studies have revealed that surgical resection of pulmonary metastases from HCC may prolong survival in selected patients [7,8,9]. To our knowledge there has been no report of a patient who has undergone resections of pulmonary metastasis after hepatectomy for a ruptured HCC. Angiography revealed dilated, tortuous and displaced arterial tumor feeders with neovasculatures showing a disorganized pattern over the right lobe of the liver. The patient's postoperative course was smooth and he was discharged on 13 March 2000 After surgery, he had regular followups with serum alpha-fetoprotein levels, chest radiographs, and abdominal ultrasonography every three months in our hospital. 2r(Foaaitrg:uiiouPngiodrntelhaynalgu2nmocnlnaeaogilnrwcmifeitcalhlals,tcwiaobinaturhn×sdhe1ai0gcn0ht)ergorrmaNna/utCilna(rnaenuodcsleainunosa-ptrhoeia-liccoyctfoygtpioalanpstlmacs)emll, 2a: Polygonal cells with higher N/C (nucleus-to-cytoplasm) ratio than normal, abundant granular eosinophilic cytoplasm, round nuclei with coarse chromatin and an area of giant cell (original magnification ×100). -2b: Metastatic hepatocellular carcinoma in lung parenchyma (original magnification ×40)
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