Generalized intraperitoneal seeding of hepatocellular carcinoma after microwave coagulation therapy: A case report

We first describe a case of generalized intraperitoneal seeding of hepatoce llular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year -old man underwent operative MCT for an exophytic HCC, 60mm in diameter, in segment IV off his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months la ter, radiographic examinations delineated several perihepatic masses with h ypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50mm in diameter, involved the transverse colon. Most of these intraabdominal m asses were removed together with the involved colon. Histologically, the in itial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progressio n and bleeding 2 months later. In conclusion, we should be aware of the pos sible occurrence of peritoneal seeding after MCT for HCC. Every effort shou ld be made to prevent this serious complication, particularly in cases of s uperficial, large, and less differentiated HCCs.