S2633 Hepatocellular Carcinoma Recurrence Presenting as an Abdominal Wall Mass

Abstract

INTRODUCTION: A 74 year-old-male with a history of NASH cirrhosis complicated by hepatocellular carcinoma (HCC) underwent orthotopic liver transplantation (OLT) in 5/2013. Surgical margins were negative for carcinoma however there were foci suggestive of vascular invasion. The patient was later found to have atypical areas of recurrence. CASE DESCRIPTION/METHODS: After OLT the patient was complication-free until he was found to have recurrence in 2017 with an elevated AFP 22.1 and an abdominal MRI which demonstrated a 1.4 × 1.1 cm focus of washout in hepatic segment VII. He was treated with transarterial chemoembolization (TACE). A repeat MRI several months later did not demonstrate this lesion however his AFP continued to increase to 89. One year later his AFP was 378.6 and an MRI demonstrated an 8 mm focus of early arterial enhancement in segment VII. His AFP subsequently increased to 1180 and another MRI showed a large right anterior lower quadrant mass without a notable liver mass (Figure 1). He had an abdominal muscle fine needle aspiration and biopsy with pathology consistent with HCC. A PET scan showed moderate uptake in the regional wall. He underwent excision of an 8 × 8 cm abdominal wall mass and small bowel resection with negative surgical margins. A colonoscopy was without malignancy. An abdomen MRI in December 2019 did not show recurrence and his most recent AFP is within normal range. DISCUSSION: Microvascular invasion is one of the most predictive factors for recurrence and is associated with poor survival1. Other factors include positive surgical margins and tumor size. Loco-regional therapy (such as TACE) before OLT may help decrease recurrence2. While most recurrences of HCC after OLT are extrahepatic this patient had recurrence within the transplanted liver. Additionally, his latest recurrence as an abdominal wall mas demonstrates an atypical location that providers should be aware of.Figure 1.: MRI pelvis without and with contrast demonstrating a large right anterior lower quadrant mass.