Abstract
We report herein the case of a 53-year-old man with disseminated intraperitoneal metastases caused by the rupture of small hepatocellular carcinoma (HCC). He was admitted to our hospital in shock after suffering a trauma injury to the upper abdomen. Ultrasonography revealed a massive hemoperitoneum. At surgery, 4000 ml of blood was drained from the abdominal cavity and a ruptured tumor, 2 cm in diameter, was found in the right lobe of the liver. The tumor was resected with an adequate surgical margin and subsequent microscopic examination confirmed a diagnosis of moderately differentiated HCC without associated liver cirrhosis. The patient was readmitted 14 months later, following the development of right lower quadrant pain. Ultrasonography and computed tomography revealed extrahepatic abdominal tumors, and abdominal angiography demonstrated four intraperitoneal tumors. At surgery, four implanted metastases adhered to the greater omentum were found and resected. No other tumors were detected. Microscopically, all four tumors were confirmed as moderately differentiated hepatocellular carcinoma. Ruptured HCC may lead to implanted intraperitoneal metastasis, but rupture of small HCC is very rare. While hepatic resection is the treatment of choice for ruptured HCC, according to our review of the literature, only a few patients have survied long-term after resection of implanted metastasis.
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The Liver Cancer Study Group of Japan (1997) Survey and follow-up study of primary liver cancer in Japan. 12th Report (in Japanese with English abstract). Acta Hepatol Jpn 38:317–330
Sato Y, Fujiwara K, Furui S, Ogata I, Oka Y, Hayashi S, Ohta Y, Iio M Oka H (1985) Benefit of transcatheter arterial embolization for ruptured hepatocellular carcinoma complicating liver cirrhosis. Gastroenterology 89:157–159
Chida T, Toshima T, Fukuda K, Onochi S, Nakajima N, Asanuma Y, Koyama K (1992) A case of primary hepatocellular carcinoma which ruptured spontaneously (in Japanese with English abstract). Jpn J Gastroenterol Surg 25:868–870
Sonoda T, Kanematsu T, Takenaka K, Sugimachi K (1989) Ruptured hepatocellular carcinoma evokes risk of implanted metastases. J Surg Oncol 41:183–186
Nagahori K, Matsuda M, Okuda J, Ba B, Yamamoto M, Matsumoto Y (1997) Hepatic resection for ruptured hepatocellular carcinoma and its recurrent pattern (in Japanese with English abstract). Acta Hepatol Jpn 38:232–237
Yamamoto M, Akahane Y, Ainota T, Itakura J, Kohno H, Nagahori K, Fujii H, Fujino M, Matsumoto M, Suzuki H (1993) Three Indonesian cases of intraperitoenal development of metastatic hepatocellular carcinoma, possibly disseminated by spontaneous tumor rupture. Yamanashi Med J 8:163–180
Shirabe K, Kitamura M, Tsutsui S, Maeda T, Matsumata T, Sugimachi K (1995) A long-term survivor of ruptured hepatocellular carcinoma after hepatic resection. J Gastroenterol Hepatol 10:351–354
Kawamata K, Satoh T, Horiuchi M, Makita T, Ueda K, Fukushima M, Inoue K, Koike T (1993) A case of ruptured metastatic tumor of the hepatocellular carcinoma on the ometum (in Japanese with English abstract). J Jpn Soc Clin Surg 54:1867–1870
Miyamoto M, Sudo T, Kuyama T (1991) Spontaneous rupture of hepatocellular carcinoma; a review of 172 Japanese cases Am J Gastroenterol 86:67–71
Cherqui D, Panis Y, Rotman N, Fagniez PL (1993) Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis. Br J Surg 80:747–749
Sakao Y, Takagi A, Maruyama Y, Kinufukuro K (1991) Evaluation of 47 cases of ruptured hepatocellular carcinoma (in Japanese). Prog Acute Abdom Med 11:679–684
Chen MF, Hwang TL, Jeng LB, Wang CS (1995) Clinical experience with hepatic resection for ruptured hepatocellular carcinoma. Hepato-Gastroenterology 42:166–168
Dewar GA, Griffin SM, Ku KW, Lau WY, Li AKC (1991) Management of bleeding liver tumors in Hong Kong. Br J Surg 78:463–466
Kew NC, Hodgkinson J (1991) Rupture of hepatocellular carcinoma as a result of blunt abdominal trauma. Am J Gastroenterol 86:1083–1085
Nakashima T, Okuda K, Kojiro M (1983) Pathology of hepatocellular carcinoma in Japan. Cancer 51:863–877
Inoue S, Nagao T, Wakabayashi T, Beck Y, Shimizu K, Watanabe K, Tomikawa S, Mita K, Sugimoto H, Uchida H (1992) Spontaneous rupture of hepatocellular carcinoma; an approach with delayed hepatectomy. Surg Today 22:474–480
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Kosaka, A., Hayakawa, H., Kusagawa, M. et al. Successful surgical treatment for implanted intraperitoneal metastases of ruptured small hepatocellular carcinoma: Report of a case. Surg Today 29, 453–457 (1999). https://doi.org/10.1007/BF02483040
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DOI: https://doi.org/10.1007/BF02483040