Hepatocellular carcinoma presenting as an extrahepatic mass: A case report and review of literature

Table 1 Previously reported cases of extrahepatic hepatocellular carcinoma presentation without known primary hepatic lesion¹

Center (number of cases)	Country	Report year	Site of extrahepatic HCC presentation	Largest dimension (cm)	AFP (ng/mL)	Diagnosis achieved by	Liver imaging at time of resection or biopsy	Follow-up duration (months)	Status at follow-up	Ref.
Metastatic HCC
Brigham and Women’s Hospital, Deaconess Hospital, Cardinal Cushing Hospital (7)	United States	1986	Retrogastric (1), ovarian (1), adrenal (1), omental (1), peripancreatic (3)	Not reported	Not reported	Resection (6), autopsy (1)	Not reported	Not reported	Not reported	Longmaid et al[9]
Centre Régional de Lutte Contre le Cancer	France	1995	Skull	8	66000	Resection	CT	35	Alive, recurrence-free	Raoul et al[29]
Universita Degli Studi Di Parma	Italy	1998	Left iliac bone	10	“Normal”	Resection	CT	45	Alive, recurrence-free	Iosca et al[30]
Ankara University Medical School	Turkey	2004	Left chest wall	7	60000	Biopsy	CT, ultrasound	< 1	Palliative, deceased	Coban et al[31]
Tata Memorial Hospital	India	2005	Umbilical, lung	6.5	63235	Biopsy	CT	Not reported	Not reported	Shah et al[32]
Tata Memorial Hospital	India	2005	Sternum	9	18303	Biopsy	CT	5	Disease progression, deceased	Qureshi et al[33]
Aristotle University of Thessaloniki	Greece	2005	Adrenal	10	75.6	Resection	CT, Ultrasound	10	Disease progression, deceased	Tsalis et al[34]
Mayo Clinic	United States	2005	Mesentery	Not reported	“Normal”	Biopsy	CT, Ultrasound	8	Disease progression, deceased	Batsis et al[35]
Hanyang Medical Center	South Korea	2006	Left chest wall	12	308	Resection	CT, Ultrasound, MRI	12	Vertebral metastasis, no hepatic lesions	Hyun et al[36]
University of Pittsburgh	United States	2007	Left chest wall	15	16125	Resection	CT, MRI	Not reported	Not reported	Khalbuss et al[12]
Nara Medical University	Japan	2010	Left iliac bone	20	115	Biopsy	CT, MRI, angiography	120	Alive, recurrence-free after TACE	Takahama et al[37]
Yonsei University College of Medicine	South Korea	2012	Right iliac bone	13	15	Biopsy	CT, MRI, angiography, PET	12	Disease progression, alive	Jung et al[38]
University of Malaya	Malaysia	2014	Mediastinum	Not reported	709	Biopsy	CT	1	Deceased	Koh et al[13]
College of Medicine, the Catholic University of Korea	South Korea	2015	Cervical vertebrae, right iliac bone	7.6	5013	Debulking	CT, MRI	6	Lung metastases, alive	Hwang et al[39]
Changi General Hospital	Singapore	2015	Adrenal	14	33127	Biopsy	CT	2	Disease progression, deceased	Mundada et al[40]
Khyber Teaching Hospital	Pakistan	2015	Right ilium, vertebrae	20	108795	Biopsy	CT, MRI	Not reported	Not reported	Abbas et al[41]
KMCT Medical College	India	2016	Adrenal	7.6	“Normal”	Resection	CT	7	Disease progression, alive	Pradeep et al[11]
Saiseikai Kanazawa Hospital	Japan	2022	Thoracic vertebrae	Not reported	3.1	Biopsy	CT	8	Disease progression, deceased	Shirota et al[42]
HCC arising from ectopic liver tissue2
Center for Adult Diseases, Osaka	Japan	1973	Lesser sac	24	Not reported	Autopsy	Autopsy	N/A	N/A	Horiuchi
Kanazawa University	Japan	1988	Multifocal peritoneum, diaphragm	Not reported	117000	Resection	CT, ultrasound, angiography	39	Multifocal metastases in liver, deceased	Kawahara et al[43]
National Cancer Center Institute	Japan	1994	Left diaphragm	3	2207	Resection	CT, angiography	96	Alive, recurrence-free	Takayasu et al[44]
Università di Udine	Italy	1994	Left subphrenic	6.5	2325	Resection	CT, angiography	12	Alive, recurrence-free	Basile et al[16]
Ohmuta Municipal Hospital, Chiba University School of Medicine	Japan	1999	Gastric	4	4900	Resection	CT, ultrasound, angiography	12	Multifocal hepatic and pulmonary metastases, deceased	Arakawa et al[10]
Université Bordeaux	France	1999	Left subphrenic	Not reported	Not reported	Resection	MRI	Not reported	Not reported	Le Bail et al[45]
Hôpital Beaujon	France	2000	Chest wall	11	“Normal range”	Resection	CT, ultrasound, MRI, angiography	36	Alive, recurrence-free	Asselah et al[46]
Korea University College of Medicine	South Korea	2003	Left subphrenic	9	Not measured	Resection	CT	23	Multifocal hepatic metastases, alive	Kim et al[47]
Molinette Hospital (3)	Italy	2003	Gallbladder (1), perisplenic (2),	9 (2), 10 (1)	4000 in one	Resection	CT	48-alive, recurrence-free; 4-multifocal hepatic recurrence; 48-alive, recurrence-free		Leone et al[48]
Otsu Red Cross Hospital	Japan	2006	Lower abdomen / small bowel	7	99100	Resection	CT, MRI, angiography	18	Alive, single hepatic recurrence	Shigemori et al[49]
National Defense Medical Center	Taiwan	2007	Left diaphragm	10	45000	Resection	CT, ultrasound	8	Alive, recurrence-free	Huang et al[50]
University of Florida College of Medicine	United States	2007	Pancreatic	3.7	Not reported	Resection	CT	15	Alive, recurrence-free	Cardona et al[51]
National Taiwan University College of Medicine	Taiwan	2007	Lower abdomen / small bowel	15	87500	Resection	CT, ultrasound, MRI	Not provided	Not provided	Liu et al[52]
Dokkyo University Hospital	Japan	2007	Pancreatic	6.5	Not measured	Resection	CT, MRI, angiography	36	Alive, recurrence-free	Kubota et al[53]
Korea University College of Medicine	South Korea	2008	Left subphrenic	4.1	“Within normal limits”	Resection	CT	Not reported	Not reported	Seo et al[17]
Chhatrapati Shahuji Maharaj Medical University	India	2010	Left suprarenal	8	“Strongly positive”	Resection	CT	6	Multifocal metastasis, deceased	Singh et al[54]
Oita University Faculty of Medicine	Japan	2011	Left subphrenic	Not provided	84865	Biopsy	CT	Not provided	Not provided	Nishikawa et al[55]
Hekinan Municipal Hospital	Japan	2011	Perisplenic	6	Not reported	Autopsy	CT	33	Deceased	Matsuyama et al[56]
Fukuoka University	Japan	2012	Diffuse peritoneal	1	241	Biopsy	CT, PET	Not provided	Systemic treatment for disseminated disease	Miyake et al[57]
Recep Tayyip Erdogan University Training and Research Hospital	Turkey	2014	Para-aortic / adrenal	6.4	20000	Biopsy	CT, Ultrasound	Not provided	Not provided	Yuce et al[58]
University of Oslo	Norway	2015	Left subphrenic	3.5	200	Resection	CT, ultrasound, MRI	48	Alive, 3 focal recurrences resected	Aarås et al[59]
Inje University College of Medicine	South Korea	2015	Left subphrenic	3.8	Not provided	Resection	CT	17	Alive, recurrence-free	Lee et al[60]
Third Military Medical University, Chongqing	China	2016	Multifocal (perigastric, paraortic, pulmonary)	6.4	24793	Biopsy	CT, MRI, PET	15	Alive, on systemic therapy	Cui et al[61]
Medical University of Lodz	Poland	2017	Pancreatic	2.5	“Not elevated”	Resection	CT	24	Alive, recurrence-free	Braun et al[62]
West China Hospital, Sichuan University	China	2017	Pancreatic	5	1200	Resection	CT, ultrasound, MRI, PET	21	Alive, recurrence-free	Li et al[63]
Zhejiang University School of Medicine	China	2017	Multifocal (gastrohepatic ligament, perisplenic, pelvic)	30	8.0	Resection	CT, MRI	22	Multifocal recurrences, deceased	Jin et al[64]
University of Arkansas for Medical Sciences	United States	2017	Within choledochal cyst	Not provided	2.9	Biopsy	CT	Not provided	Not provided	George et al[65]
Complejo Hospitalario de Navarra	Spain	2019	Mesentery	8	651	Resection	CT, ultrasound	24	Alive, recurrence-free	Martínez-Acitore et al[66]
Kumamoto University	Japan	2020	Peripancreatic	7.5	1.7	Resection	CT, MRI, PET	8	Alive, recurrence-free	Adachi et al[14]
New York Medical College	United States	2021	Adrenal	9.1	1.9	Resection	CT, MRI	10	Alive, multifocal recurrence	Wei et al[67]

¹Cases of extrahepatic hepatocellular carcinoma (HCC) presentation with workup identifying concurrent hepatic tumors and cases of pedunculated HCC with extrahepatic growth were excluded.

²Of 17 additional cases of ectopic hepatocellular carcinoma were identified in the review by Arakawa et al[10] with reports only available in Japanese.

AFP: Alpha-fetoprotein; CT: Computed tomography; MRI: Magnetic resonance imaging; PET: Positron emission tomography; TACE: Trans-arterial chemoembolization; HCC: Hepatocellular carcinoma.