Laparoscopic resection of recurrent ectopic hepatocellular carcinoma: A case report with review of the literature and guidelines for follow-up

Arne Marino Aarås; Truls André Reitan-Gjersøe; Anne Waage; Tom Mala; Bjørn Edwin; Else Marit Løberg; Andreas Abildgaard; Bård Ingvald Røsok

doi:10.1016/j.ijscr.2015.10.014

Laparoscopic resection of recurrent ectopic hepatocellular carcinoma: A case report with review of the literature and guidelines for follow-up

Int J Surg Case Rep. 2015:17:92-5. doi: 10.1016/j.ijscr.2015.10.014. Epub 2015 Oct 28.

Authors

Arne Marino Aarås¹, Truls André Reitan-Gjersøe², Anne Waage³, Tom Mala⁴, Bjørn Edwin⁵, Else Marit Løberg⁶, Andreas Abildgaard⁷, Bård Ingvald Røsok³

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: trulsagjersoe@gmail.com.
³ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
⁴ Department of Gastrointestinal Surgery, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.
⁵ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; The Interventional Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
⁶ Department of Pathology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.
⁷ Department of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.

Abstract

Introduction: Hepatocellular carcinoma (HCC) in ectopic liver tissue is extremely rare.

Presentation of case: A 64-year-old woman presented initially with abdominal complaints. Computed tomography (CT) revealed a tumor in the diaphragm and laparoscopic resection of the tumor was performed. Histology showed HCC. During the next 4 years four more tumors, all of which showed HCC on histology and were located extrahepatically, was treated with laparoscopic resection. During this course the patient was followed with regular thoracoabdominal CT and measurement of serum alpha-fetoprotein (AFP). A negative magnetic resonance imaging (MRI) examination of the liver excluded a primary intrahepatic tumor.

Discussion: The literature available on ectopic HCC and the guidelines for management of HCC do not address the postoperative surveillance of patients undergoing curative treatment. A follow-up regime has been proposed by Hatzaras et al. (2014) to include cross-sectional imaging of the liver and measurement of serum AFP levels [1]. CT would be the preferred study of choice in a total radiologic investigation of the abdomen. While MRI is prone to artifacts due to movements, CT scans allows so rapid recordings that this no longer is an issue. An early investigation of the liver for intrahepatic HCC should nevertheless be performed early to exclude primary intrahepatic HCC.

Conclusion: We recommend that patients with ectopic HCC should be followed every 6 months with measurement of AFP and abdominal CT imaging. MRI of the liver should be performed early to exclude primary intrahepatic HCC.

Keywords: Carcinoma; Ectopic; Follow-up; Hepatocellular; Laparoscopic; Resection.