case_images: PMC7204886_01
case_images: 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).
case_images: crg-0014-0226-g01.jpg
case_images: PMC7204886_01_crg-0014-0226-g01.jpg
case_images: F1
case_images: 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).
case_images: 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).
case_images: crg-0014-0226-g02.jpg
case_images: PMC7204886_01_crg-0014-0226-g02.jpg
case_images: F2
case_images: 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.
case_images: 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.
case_images: crg-0014-0226-g03.jpg
case_images: PMC7204886_01_crg-0014-0226-g03.jpg
case_images: F3
case_images: One month after the cessation of sorafenib, the serum PIVKA-II level increased abruptly (Fig. 3).