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- W2979952024 abstract "INTRODUCTION: Liver biopsy (LB) is a known risk factor for tumor seeding and hepatocellular carcinoma (HCC) recurrence. The time from LB to confirmed needle tract seeding (NTS) varies from 3 months to 4 years. We present case of recurrent HCC due to NTS 13 years after LB who presented with a right intercostal wall mass. CASE DESCRIPTION/METHODS: A 32-year-old Caucasian male presented to his primary care provider (PCP) in 2004 with recurrent right upper abdominal pain. A CT abdomen & pelvis showed 15 × 12 × 12 cm lesion in the right lobe of the liver with central hypodensity and 1-2 cm solid peripheral rim. His PCP requested CT guided percutaneous needle biopsy. Cytologic analysis was negative for malignant cells. After referral to our institution he underwent posterior right hepatectomy. A 14 × 12 × 7 cm well circumscribed tumor was removed with histopathology confirming well-differentiated HCC with negative margins (Figure 1A). In 2007, new hepatic lesions were noted during HCC surveillance for which he underwent orthotopic liver transplantation (OLT). He continued HCC surveillance which included CT abdomen, pelvis and thorax every 1- and 3-years, whole body bone scintigraphy every 3 years and abdominal US every 6-month intervals; which were negative for HCC recurrence. In 2017 (13 years post OLT), he returned with six months of right intercostal pain and swelling. CT chest & abdomen showed a large mass involving the right 10 th rib, soft tissue, and lung nodules (Figure 2). Biopsy of the mass showed well-differentiated HCC, suspicious for vascular invasion (Figures 1B and 3). He was initially started sorafenib however could not tolerate it. He could not receive nivolumab due to risk of rejection and is currently on cabozatinib. He received palliative radiation for pain related to metastasis. DISCUSSION: This case highlights NTS from the LB resulting in HCC recurrence and potentially compromising curative therapies such as hepatectomy and OLT. NTC in HCC is rare with a reported incidence from 1 to 5% and could potential implant 1,000 to 100,000 malignant cells along the needle tract. Due to the risk of NTS, percutaneous biopsy is avoided in indeterminate nodules and should be used only in selected cases. Prompt referral to an experienced hepatologist is imperative. LB should be reserved for lesions in which no definitive surgical intervention is planned, and pathological confirmation is necessary for non-surgical therapy." @default.
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- W2979952024 date "2019-10-01" @default.
- W2979952024 modified "2023-10-18" @default.
- W2979952024 title "2218 Recurrent Hepatocellular Carcinoma From Needle Tract Seeding 13 Years Post-Transplant" @default.
- W2979952024 doi "https://doi.org/10.14309/01.ajg.0000598404.56125.69" @default.
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