PMC6188071_01
Left: Preoperative abdominal CT. Solid hepatic lesion at segments VI and VII (arrows) and calcified lesion at the tail of the pancreas (circle). Right: Postoperative abdominal CT. Subcapsular hepatic fluid collection without recurrence of the HCC (circle).. Abbreviations: CT, computed tomography; HCC, hepatocellular carcinoma.
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Seven years after the initial treatment for breast cancer, abdominal CT revealed a solid hepatic lesion at segments VI and VII measuring 7 cm in diameter as well as a 1 cm calcified lesion at the tail of the pancreas (Figure 1, left). Follow-up abdominal CT scanning on the first and sixth month after the operation showed subcapsular hepatic fluid collection without recurrence of the HCC (Figure 1, right).
(A) Scar lesion from the pancreas (H&E 100X). (B) The tumor cells are arranged in abnormal and thick trabeculae (H&E 100X). (C) The neoplastic cells are positive for HepPar1 (Immunostain 200X). (D) The neoplastic cells are positive for AFP (Immunostain 200X).
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Moreover, after entering the lesser sac, a second rapid biopsy was taken from the lesion at the pancreatic tail which showed chronic fibrosis without elements of malignancy (Figure 2A). Immunohistochemistry showed that cancer cells highly expressed keratins 8/18, Hep-Par 1 and AFP and did not express keratin 7 and GATA-3 (Figure 2B-D).
Left: Intraoperative photo. Microwave tissue coagulator marking the margins for hepatic segmentectomy. Right: Gross specimen photo. Hepatic segments VI and VII containing the HCC.. Abbreviation: HCC, hepatocellular carcinoma.
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Hepatic segmentectomy was achieved using a microwave tissue coagulator to mark and coagulate the margins of hepatectomy and ultrasound harmonic scalpel to transect the hepatic parenchyma with a minimal blood loss of 40 cc (Figure 3).