Primary Hepatocellular Carcinoma in Ectopic Liver and Later Metastasis to Mother Liver: A Case Report and Review of the Literature

異位性肝癌(Ectopic HCC)是指異位性肝臟組織發生肝癌，好發於老年男性病人，臨床上多爲意外發現，其表現症狀可能有腹痛、腹脹、腹腔內出血合併胎兌蛋白(AFP)上昇。通常異位性肝癌發現時，大部分病人沒有病毒性肝炎、肝硬化或原發性肝癌，目前主要治療方式爲手術切除，多數病例報告都有不錯的預後，但缺乏長期追蹤的報告。我們提出一位六十四歲女性病人，本身沒有病毒性肝炎與肝硬化病史，因腹腔內出血性休克，意外在腹膜上發現兩顆破裂的異位性肝癌。經手術切除追蹤一年後，胎兒蛋白(AFP)開始上昇，接受一系列影像學檢查，肝臟與腹腔內並沒有發現腫瘤。直至術後二十八個月，肝臟才發現兩顆小於兩公分肝癌，接受酒精注射與栓塞治療後，肝臟腫瘤沒有復發的現象。但胎兒蛋白(AFP)仍然持續增加，病人接受定期影像監到，直至術後五十三個月，終於發現腹膜有多發性肝癌發生，此時肝臟仍然沒有肝硬化或新的肝癌發生。有鑑於此，病人的臨床診斷推測應爲異位性肝癌經手術切除後，長期追蹤發現轉移至肝臟，與腹膜，病人於術後八十五個月因病情急化死亡。我們整理類似的病例報告後，發現異位性肝癌手術切除後，如果胎兒蛋白(AFP)仍然持續增加，就算影像學檢查沒有證實復發，也應考慮接受更積極的治療（如化學治療），可能會有較佳的預後。

關鍵字

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並列摘要

We are presenting a case of primary ectopic hepatocellular carcinoma (HCC) that later developed HCC in the mother liver during long-term follow-up. A 64-year-old woman presented with a sudden onset of abdominal pain and internal bleeding. Ectopic HCC was diagnosed by the surgical resection of 2 tumors during laparotomy, which were found near the triangular ligament and lesser curvature of the stomach. Imaging studies revealed no intrahepatic lesion or peritoneal tumors during follow-up. However, 2 small HCCs in the mother liver were detected two years after surgery without peritoneal recurrence. Progressive alpha-fetoprotein elevation was noted despite the complete ablation of the mother liver HCC by image study. Recurrent peritoneal HCC carcinomatosis was detected and confirmed by exploratory laparotomy two years later. The patient died because of disease progression seven years after the peritoneal tumors resection without HCC recurrence in the mother liver. A literature review disclosed 7 ectopic HCC cases, including the present one, who developed mother liver HCC during the follow-up period. Regular serum AFP level monitoring and image studies are recommended for detecting recurrent or metastatic HCC after tumor resection.

並列關鍵字

Adjuvant chemotherapy ； Ectopic hepatocellular carcinoma ； Tumor rupture

國際替代計量

Primary Hepatocellular Carcinoma in Ectopic Liver and Later Metastasis to Mother Liver: A Case Report and Review of the Literature

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