Abstract
The case of a 78-year-old man with hepatocellular carcinoma (HCC) that was implanted along the needle tract to the skin, chest wall, and diaphragm 2 years and 9 months after biopsy is reported. A needle biopsy for a 7-cm-diameter tumor was performed, and the tumor was diagnosed as HCC. Extended medial segmentectomy and cholecystectomy were performed. One year and 10 months after the biopsy, two HCC recurrences were recognized, and partial hepatectomies were then performed. Two years and 9 months after the biopsy, tumors at the skin, chest wall, and diaphragm along the needle tract and in the liver were recognized. The excisional biopsy of the skin tumor revealed that this tumor was moderately differentiated HCC. Partial hepatectomy, tumor extirpations of the chest wall and diaphragm, and mesh repair of the chest wall were performed. The resected tumors were all diagnosed as moderately differentiated HCC, and this recurrence was diagnosed as an intrahepatic recurrence with needle tract implantation by biopsy. Thereafter, 4 hepatic resections and 5 lipiodolizations (total 6 times) were performed, and sorafenib was administered for repeated intrahepatic recurrences of HCC, and this patient survived for 9 years and 1 month after the needle biopsy.
As mentioned in the HCC guideline in Japan, the indication for biopsy of a liver tumor should be carefully considered in light of the risk of tumor implantation, and long-term follow-up of patients who have undergone a biopsy should be conducted, keeping in mind the risk of needle tract implantation. Treatment plans for patients with HCC should be developed knowing that aggressive treatments such as repeated resections for HCC recurrence, including needle tract implantation, can lead to long-term patient survival.
