A resected case of ruptured hepatocellular carcinoma originating in the spiegel lobe

Abstract

A 57-year-old man with chronic hepatitis B was referred to our hospital because of the sudden onset of severe abdominal pain. Abdominal CT scan showed enhanced heterogeneous masses measuring about 4.5cm and 2.5cm in diameter in the Spiegel lobe and the segment 8 of the liver, respectively, with a huge hematoma in the omental bursa. Although there was no evidence of extravasation from the tumors on abdominal angiography, the diagnosis of spontaneous rupture of hepatocellular carcinoma originating in the Spiegel lobe was made based on the location of the hematoma. Subsequently, transarterial embolization was performed. After a two-month interval from the episode of rupture, the resection of the Spiegel lobe and partial resection of the segment 8 of the liver were conducted under the diagnosis of multiple hepatocellular carcinoma. The histological diagnosis of the tumor of the Spiegel lobe was moderately differentiated hepatocellular carcinoma with extensive necrosis and hemorrhage. The patient died of recurrence of hepatocellular carcinoma 16 months after the initial surgery.
In a review of 13 cases, including our case, in the Japanease literature, we conclude that hematoma in the omental bursa may be a characteristic finding of ruptured hepatocellular carcinoma in the caudate lobe.