Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 21, 2007; 13(31): 4270-4273
Published online Aug 21, 2007. doi: 10.3748/wjg.v13.i31.4270
Ectopic hepatocellular carcinoma arising from pancreas: A case report and review of the literature
Keiichi Kubota, Junji Kita, Kyu Rokkaku, Yoshimi Iwasaki, Tokihiko Sawada, Johji Imura, Takahiro Fujimori
Keiichi Kubota, Junji Kita, Kyu Rokkaku, Yoshimi Iwasaki, Tokihiko Sawada, Second Department of Surgery, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan
Johji Imura, Takahiro Fujimori, Department of Surgical and Molecular Pathology, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Keiichi Kubota, MD, PhD, Professor and Chairman, Department of Gastroenterological Surgery, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan. kubotak@dokkyomed.ac.jp
Telephone: +81-282-861111-2633 Fax: +81-282-866317
Received: March 8, 2007
Revised: April 2, 2007
Accepted: April 4, 2007
Published online: August 21, 2007
Abstract

A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.

Keywords: Hepatocellular carcinoma; Ectopic liver; Ectopic hepatocellular carcinoma; Pancreas; Pancreatic tumor; Islet-cell tumor