Metastasis of Hepatocellular Carcinoma to the Ovary: A Case Report and Review of the Literature

Metastasis of hepatocellular carcinoma (HCC) to the ovary is notably rare. We present a case of HCC metastasis to the ovary with a review of the literature, which includes only 7 reported cases. A 43-year-old hepatitis B virus carrier was admitted with a right ovarian cystic mass. She had been diagnosed with HCC 2 years prior, for which she underwent transarterial chemoembolization followed by right posterior sectionectomy. Eight months after the hepatectomy, the first intrahepatic recurrence was detected and treated with transarterial chemoembolization. An additional intrahepatic recurrence occurred 12 months after transarterial chemoembolization and was managed with left medial sectionectomy and intra-operative radiofrequency ablation. Over the following 3 months, the patient developed elevated alpha-fetoprotein, and positron emission tomography showed a cystic mass in the right side of the pelvic cavity with focal hypermetabolic activity, which suggested a site of recurrent HCC. An exploratory laparotomy was performed, and a soft, ovoid cystic mass was identified in the right ovary. There was no evidence of metastases in the liver, left ovary, or peritoneum. Because of the absence of tumor on the surface of the ovary and the lack of peritoneal seeding, the mode of metastasis was thought to be hematogenous. Therefore, a right salphingo-oophorectomy was performed. The pathological features showed metastatic HCC with clear resection margins. Although metastasis of HCC to the ovary is very rare, it should be suspected in a female patient with a lower abdominal mass and an elevated serum AFP level in the absence of other demonstrable metastases.

Palliative Hepatectomy for Advanced Hepatocellular Carcinoma with Multiple Metastases: A Case Report

Non-surgical treatment is usually performed for the cases of hepatocellular carcinoma (HCC) that are not suitable for curative treatment, such as those cases with a large tumor size with an insufficient hepatic remnant after resection, those cases with extensive and multifocal bilobar tumors or those cases with extrahepatic metastases of the disease. However, in this case report we present a case of palliative hepatectomy for treating advanced HCC with multiple metastases and the patient has had an excellent 1-year follow-up outcome. A 71-year-old man was referred to our hospital and the imaging studies showed a 10 cm mass in the right liver, with multiple variable sized masses in both lungs and a 1 cm nodule in the left adrenal gland. A lung biopsy revealed HCC; therefore, the working diagnosis was HCC with multiple lung metastases and a left adrenal gland adenoma or metastasis. We expected the cause of death would be deterioration of the hepatic function as the liver mass increased in size. Therefore, we performed a palliative right trisectionectomy for the primary liver mass. After recovery from the hepatectomy, the patient was managed with sorafenib. During the 1-year follow-up period after palliative hepatectomy, the patient is still alive with a good general performance status and no evidence of intrahepatic recurrence, even though there has been an aggravation of the lung metastases in size and number, and a slight increase in the size of the left adrenal gland. We suggest that in highly selected patients with advanced HCC and multiple extrahepatic metastases, and especially in the cases involving a large HCC with mild liver cirrhosis and a good general performance status, an aggressive treatment strategy with palliative hepatectomy can be an optional treatment modality to improve the overall survival.

Palliative Hepatectomy for Advanced Hepatocellular Carcinoma with Multiple Metastases: A Case Report

Non-surgical treatment is usually performed for the cases of hepatocellular carcinoma (HCC) that are not suitable for curative treatment, such as those cases with a large tumor size with an insufficient hepatic remnant after resection, those cases with extensive and multifocal bilobar tumors or those cases with extrahepatic metastases of the disease. However, in this case report we present a case of palliative hepatectomy for treating advanced HCC with multiple metastases and the patient has had an excellent 1-year follow-up outcome. A 71-year-old man was referred to our hospital and the imaging studies showed a 10 cm mass in the right liver, with multiple variable sized masses in both lungs and a 1 cm nodule in the left adrenal gland. A lung biopsy revealed HCC; therefore, the working diagnosis was HCC with multiple lung metastases and a left adrenal gland adenoma or metastasis. We expected the cause of death would be deterioration of the hepatic function as the liver mass increased in size. Therefore, we performed a palliative right trisectionectomy for the primary liver mass. After recovery from the hepatectomy, the patient was managed with sorafenib. During the 1-year follow-up period after palliative hepatectomy, the patient is still alive with a good general performance status and no evidence of intrahepatic recurrence, even though there has been an aggravation of the lung metastases in size and number, and a slight increase in the size of the left adrenal gland. We suggest that in highly selected patients with advanced HCC and multiple extrahepatic metastases, and especially in the cases involving a large HCC with mild liver cirrhosis and a good general performance status, an aggressive treatment strategy with palliative hepatectomy can be an optional treatment modality to improve the overall survival.