DIAPHRAGMATIC AND SUBCUTANEOUS SEEDING OF HEPATOCELLULAR-CARCINOMA FOLLOWING FINE-NEEDLE ASPIRATION BIOPSY

Aims/Background: We report the discovery of associated metastatic subc utaneous and metastatic diaphragmatic nodules on the needle track afte r fine-needle biopsy aspiration under echography, which has not yet be en reported in the literature. Methods. A 35-year-old man with nonrepl icating hepatitis B virus presented with a tumor that suggested hepato carcinoma with cirrhosis. A diagnostic needle biopsy was carried out b efore surgery. Twelve months later, he presented with a series of four continuous metastatic diaphragmatic nodules on the inner wall lining the needle track. Surgery was performed, followed by external radiatio n (40 Gy). Conclusions. The risk of seeding following fine-needle biop sy aspiration of hepatocellular carcinoma can no longer be considered negligable. The real risk is probably underestimated. Even for biopsy of lesions localized to the inferior part of the liver, diaphragmatic seeding is possible. This seeding necessitates surgical resection, inc reasing the therapeutic morbidity of hepatocellular carcinomas. We bel ieve that in cases where investigation of a small hepatic tumor sugges ts a hepatocellular carcinoma that could be resected, or for candidate patients for liver transplantation, one should not puncture the tumor . If this diagnostic biopsy is essential, then the needle track could be resected upon surgery, after cutaneous external tattooing.