Unusual Presentation of Hepatocellular Carcinoma with Peritoneal Carcinomatosis: Importance of Abdominal Distension as a Clinical Indicator

Abstract

Hepatocellular carcinoma (HCC) is a common malignancy of the liver. It is frequently diagnosed in the male gender with a racial predilection towards Asian and African populations. In addition to distant metastasis, large tumors can result in direct extrahepatic metastasis to the peritoneum and diaphragm through rupture of exophytic tumor hepatocellular carcinoma in peritoneal cavity. We report a case of a 55-year-old male having hepatocellular carcinoma secondary to hepatitis C with peritoneal metastasis. The CT abdomen with contrast triphasic study was suggestive of alarming features of chronic liver disease with multicentric hepatoma formation predominantly in segment VIII with the localized subcapsular collection. Additionally, an extensive omental thickening and nodularity were also seen in subhepatic space. Multiple nodules were seen in right cardiophrenic angle, right lower abdomen, and rectovesical pouch. In contrast to conventional chemotherapy with sorafenib, cytoreduction surgery with hyperthermic intraperitoneal chemotherapy has been shown to dramatically improve survival in patients.