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- W1658362783 abstract "An 82-year-old man was referred to our hospital with a presumed metastasis on the liver surface. Thirty months previously, he had been treated with a segmental resection of the liver (segments VI and VII) for a solitary hepatocellular carcinoma, approximately 5 cm in diameter. The appearance on a computed tomography (CT) scan, with and without enhancement by contrast, is shown in Figure 1. There is a small nodule, approximately 1.5 cm in diameter, that appears to be located on the surface of the liver and shows striking enhancement during the arterial phase of the CT (Figure 1, right). Serum levels of alpha-fetoprotein and des-γ-carboxy prothrombin (PIVKA-II) were within the reference range. Other investigations were performed but there was no evidence of additional intrahepatic or extrahepatic metastases. The tumor was presumed to be a local recurrence at the site of the hepatic incision or perhaps a solitary peritoneal metastasis. At laparotomy, there were extensive adhesions between the liver and the diaphragm and the tumor was resected en bloc with parts of both the diaphragm and liver. Macroscopically, the tumor occupied the intraphrenic space but not the subphrenic space (Figure 2). Histologically, there was a moderately-differentiated hepatocellular carcinoma that was covered in striated muscle (Figure 2, arrows). The appearance of the neoplasm was similar to that of the initial operative specimen. The diagnosis was that of a diaphragmatic metastasis from hepatocellular carcinoma. He remains in good health, 12 months after the second operation. The frequency of extrahepatic metastases in patients with hepatocellular carcinoma ranges from 13% to 37%. The most common sites for metastases are the lungs, lymph nodes, bones, adrenal glands and spleen. Metastases within the diaphragm appear to be extremely rare although there is one case report of ectopic hepatocellular carcinoma of the diaphragm. One possible mode of spread to the diaphragm is via the systemic circulation although it is difficult to believe that such a metastasis would be located close to the operative incision. Other possibilities include direct spread at the time of surgery or spread to the diaphragm through lymph channels that drain foreign material, pathogens and toxins from the peritoneal cavity. The latter route has been called the mesothelial stomata and appears to be the preferred mode of spread in this rare case." @default.
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- W1658362783 date "2009-08-01" @default.
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- W1658362783 title "Hepatobiliary and pancreatic: Isolated diaphragmatic metastasis from hepatocellular carcinoma" @default.
- W1658362783 doi "https://doi.org/10.1111/j.1440-1746.2009.05962.x" @default.
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