A Case of Ruptured Hepatocellular Carcinoma having neither Hepatitis B nor Hepatitis C Virus Infection in a Young Adult Patient

Nobuhiko Okamoto, Kazuo Yamafuji, Kiyoshi Kubochi, Atsunori Asami, Kaoru Takeshima, Noritaka Hayashi and Hideo Baba

Department of Surgery, Saitama Municipal Hospital

A 25-year-old woman admitted for severe upper abdominal pain was found in ultrasonography to have a low echoic area in the lateral hepatic segment and free fluid was confirmed in the Morrison pouch, Douglas pouch and left subphrenic space. These findings and her shock status on presentation suggested intraabdominal hemorrhage due to hapatic tumor rupture. Enhanced computed tomography (CT) revealed extravasation from the liver tumor in segment 3. She underwent therapeutic arterial embolization (TAE) achieving successful hemostasis. Serum AFP and protein induced vitamin K absence (PIVKA) II were very high, yielding a definitive diagnosis of hapatocellular carcinoma. After initial recovery, she was considered suitable for curative hepatic resection and underwent left lateral segmentectomy. Peritoneal dissemination was not confirmed in laparotomy. Histological examination of the resected specimen showed moderately differentiated hepatocellular carcinoma. She has been regularly followed up and has shown no sign of tumor recurrence in the 21 months since surgery.

Key words
ruptured hepatocellular carcinoma, juvenile hepatocellular carcinoma, hepatocellular carcinoma without viral infection

Reprint requests
Nobuhiko Okamoto Department of Surgery, Saitama Municipal Hospital
2460 Mimuro, Midori-ku, Saitama, 336-8522 JAPAN

Accepted
January 27, 2010

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