PMC7204886_01
a-c CT shows multiple contrast-enhanced tumors on arterial phase in the abdominal cavity. a The 55-mm main tumor with cystic lesions located in the lower right abdomen. b, c Multiple tumors of approximately 20 mm in size scattered throughout the mesentery. d Tumors in the abdominal cavity showing a slight increase in 18F-fluorodeoxyglucose uptake on positron emission tomography-CT image (maximum standardized uptake value: 2.88 g/mL).
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F1
Ultrasonography revealed a 5.5-cm tumor near the ileocecal junction, while contrast-enhanced computed tomography (CT), and positron emission tomography-CT showed multiple nodules with cystic lesions in the peritoneum, suggesting peritoneal dissemination in addition to the main tumor (Fig. 1a-d).
Pathological findings of the peritoneal tumors were compatible with the diagnosis of ectopic HCC. a Large area of tumor cells in a trabecular pattern was revealed on HE staining, under 100-fold magnification. b HE stain of the same tissue showing tumor cells with relatively abundant eosinophilic cytoplasm under 200-fold magnification (x200). c-f Tumor cells were positive for alpha methyl acyl coenzyme A racemase (p504s), CK 8, AFP, and PIVKA-II, respectively, on immunohistochemical staining. HE. x200. g-j Tumor cells showing weak positivity for anti-hepatocyte, CK 18, heat shock protein (HSP) 70, and glypican 3, respectively, on immunohistochemical staining (x200).
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F2
Histological examination revealed tumor cells with a relatively abundant cytoplasm and a large area of hyperplasia in a palisading pattern (Fig. 2). A racemase, cytokine (CK) 8, alpha-fetoprotein (AFP), and protein induced by vitamin K absence or antagonist-II (PIVKA-II), and weakly positive for anti-hepatocyte, CK 18, heat shock protein 70, and glypican 3 (Fig. 2). According to the abovementioned results, HCC of the abdominal wall with peritoneal seeding was diagnosed.
Serum levels of tumor markers continued to rise despite initiation of sorafenib treatment. Sorafenib was ceased 7 months after the start of treatment. One month after the cessation, the PIVKA-II level rose abruptly.
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F3
One month after the cessation of sorafenib, the serum PIVKA-II level increased abruptly (Fig. 3).