Surgical removal of a distinct subcutaneous metastasis of multilocular hepatocellular carcinoma 2 months after initial percutaneous ethanol injection therapy

Summary

Subcutaneous tumor seeding after percutaneous ethanol injection therapy (PEI) for hepatocellular carcinoma is a rarely seen complication. It is reported due to needle track seeding during PEI after a distance of 6-46 months. Metastatic tumor spread is described subcutaneously, to the chest wall, abdominal wall and diaphragm. We report the case of a 76-year-old patient with chronic hepatitis B infection and cirrhosis which let to a multilocular hepatocellular carcinoma who underwent PEI. This patient developed 2 months after primary PEI a subcutaneous tumor formation confined to the right lower chest wall. Surgical tumor resection was performed. The histopathological evaluation confirmed subcutaneous seeding of the preknown hepatocellular carcinoma with a maximum of 30 mm in diameter. As a risk of PEI subcutaneous metastasis of the primary tumor should be considered even in early stage of therapy and close follow-up of the patient during treatment is required. Surgical tumor resection to ensure the curative intention of PEI is advisable.

En-bloc-Resektion einer subkutanen Metastasenformation eines hepatozellulären Karzinoms 2 Monate nach Beginn der perkutanen Ethanolinjektionstherapie

Die subkutane Metastasierung des Primärtumors im Rahmen der perkutanen Ethanolinjektionstherapie ist eine seltene Komplikation. Hautmetastasen werden zwischen 6 und 46 Monaten nach initialem Therapiebeginn beobachtet und der Tumorzellversprengung aufgrund des benutzen Hohlnadelsystems zugeschrieben. Wir berichten den Fall eines 76 Jahre alten Patienten mit einer chronischen Hepatitis-B-Infektion, einer Leberzirrhose, einem multilokulären hepatozellulären Karzinom (HCC), welcher einer perkutanen Ethanolinjektionstherapie zugeführt wurde. Bereits 2 Monate nach Therapiebeginn zeigte sich bei dem Patienten eine Haut- und Lymphknotenmetastase des bekannten HCCs oberhalb des rechten M. Latissimus dorsi an der Brustwand. Es erfolgte die En-bloc-Resektion von Kutis und Subkutis im Sinne einer R0-Resektion. Die histopathologische Evaluation des Resektats zeigte eine Hautmetastase des bekannten HCCs mit einen maximalen Tumordurchmesser von 30 mm.

Resultierend empfehlen wir die engmaschige sonographische Kontrolle der Patienten während der perkutanen Ethanolinjektionstherapie sowie die frühzeitige chirurgische Intervention in kurativer Intention bei subkutaner Metastasenmanifestation.

Key words

Percutaneous Ethanol Injection Therapy - Hepatocellular Carcinoma - Needle Track Seeding - Subcutaneous Metastasis - Surgical Removal

Schlüsselwörter

Perkutane Ethanolinjektionstherapie - Hepatozelluläres Karzinom - Subkutane Metastasierung - Chirurgische Resektion

References

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