Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. It is usually manifested in the 6th and 7th decade of life. Extrahepatic metastases are seen in 64% of patients with HCC. The most frequent sites of extrahepatic metastases are lung, abdominal lymph node and bone, but peritoneal dissemination is unusual. Rupture of hepatocellular carcinoma is a life-threatening complication. The incidence of spontaneous rupture of HCC is about 8% - 26% in Asia and accounts for the 10% mortality of HCC patients. However, peritoneal metastasis after spontaneous rupture of HCC is seldom noted.
An article to be published on 28 June 2008, in the World Journal of Gastroenterology addresses this report. The research team led by Prof. Min-Chang Hung from Chang Bing Show-Chwan Memorial Hospital of Taiwan reported a case with intraperitoneal metastasis after spontaneous HCC rupture.
A previously asymptomatic 72-year-old man was admitted due to dull abdominal pain with abdominal fullness. He had rupture of hepatocellular carcinoma history ten months ago and transarterial embolization had been performed at that time. Abdominal CT scan showed a huge peritoneal mass over right upper quadrant area. Surgical resection was arranged and subsequent microscopic examination confirmed a diagnosis of moderately differentiated HCC.
Because few cases of peritoneal metastases after ruptured HCC had been reported, the association between the metastatic tumor and viral infection (HBV or HCV), AFP level, or age was lacking.