A Resected Case of Solitary Recurrence in the Diaphragm 7 Years after Surgery for Hepatocellular Carcinoma

Yoshinori Yamada, Akemi Iwamoto, Kanenori Endo, Yasuaki Hirooka and Masahide Ikeguchi

Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine

We report a rare case of hepatocellular carcinoma (HCC) with solitary recurrence in the diaphragm. A 60-year-old man undergoing lateral hepatic segmentectomy for HCC seven years earlier, and referred for elevated serum PIVKA-II concentration showed no clear evidence of HCC recurrence in computed tomography (CT), magnetic resonance imaging (MRI), or gallium scintigraphy. ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT), however, showed FDG uptake in the diaphragm near the spleen, necessitating partial diaphragm resection and splenectomy. Histopathological findings confirmed moderately differentiated HCC of the diaphragm. Following an uneventful postoperative clinical course, the man remains in good health 3 years after surgery. We found FDG PET/CT useful for detecting extrahepatic HCC recurrence and deciding on appropriate surgical strategy. Although extrahepatic HCC recurrence is associated with a dismal prognosis, it is noteworthy that extensive surgery improved the prognosis.

Key words
hepatocellular carcinoma, diaphragm, extrahepatic recurrence

Reprint requests
Yoshinori Yamada Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine
36-1 Nishi-machi, Yonago, 683-8504 JAPAN

Accepted
February 18, 2009

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