A case of disseminated extrahepatic hepatocellular carcinoma after US-guided biopsy and percutaneous ethanol injection therapy

A case of disseminated extrahepatic hepatocellular carcinoma (HCC) occurrin g after ultrasound (US)-guided biopsy and percutaneous ethanol injection th erapy is presented. A 72-year-old man with hepatitis-C-virus-related cirrho sis underwent percutanous ethanol injection therapy (PEIT) two times with c omplete remission: the first for moderately-differentiated HCC in segment s ix (S6), and the second for well-differentiated HCC in another part of S6. Imaging studies including carbon dioxide (CO2)-US angiography, incremental computed tomography, and dynamic magnet resonance imaging showed that both HCCs were hypovascular. Twenty-one months after the first PEIT and 7 months after the second, a 5.5 x 4.5 cm extrahepatic mass interfaced with S6 of t he liver was detected by imaging studies. The patient underwent surgery for extrahepatic HCC. Grossly, the main tumor was 5.5 x 4.5 cm with capsule an d septum; the disseminated tumors were detected on the surface of the liver , including the right diaphragm and the fair ligamentosa. Histologically, i t was moderately- to poorly-differentiated HCC, which, although not attribu ted to direct track seeding, was suspected of being induced by the percutan eous US-guided biopsy procedure or by PEIT, irrespective of a hypovascular tumor. Further studies may provide insight into the risk factor engendered by these procedures. (C) 2001 Elsevier Science Ireland Ltd. All rights rese rved.