Aggressive multimodal treatment for peritoneal dissemination and needle tract implantation of hepatocellular carcinoma: a case report

Weencounteredapatientwith hepatocellular carcinoma (HCC)with peritoneal dissemination and needle tract implantation, both of which were strongly suspected to have been caused by percu-taneousneedlebiopsy.Thepatientwasa65-year-oldman.Partial hepatectomyof subsegmentVI had been performed following the diagnosis of HCC by percutaneous needle biopsy in February 1997. After this first surgery, the patient additionally underwent five further surgeries for the treatment of intrahepatic recurrences, peritoneal recurrences and needle tract implantation caused by the percutaneous needle biopsy. The intrahepatic and peritoneal recurrences were surgically controlled for 3 years after the fifth operation. The needle tract implantation was first resected in February 2001. Since then, treatment by surgery and radiotherapy has been admini-stered twice for local recurrences forming tumor thrombosis of the abdominal wall. Now, 7 years after the first surgery, the patient remains alive without any evidence of recurrence. This case report serves to emphasize that needle tract implantation and peritoneal seeding caused by percutaneousneedle biopsy are rare but possible complications.Whensuch iatrogenic spreading ofmalignant cells occurs, aggressivemultimodal treatment is well worth considering.Wide resec-tion of the tumor including the adjacent soft tissues should be performed in these cases, con-sidering that the tumor spreads along the subcutaneous veins in needle tract implantation of HCC and repeated aggressive surgeries could provide good local control. Key words: hepatocellular carcinoma – percutaneous needle biopsy – peritoneal recurrence – needle tract implantatio