A Case of needle-tract implantation of hepatocellular carcinoma in the ovary after radiofrequency ablation

Article information

Kosin Med J. 2017;32(2):251-257

Publication date (electronic) : 2017 January 19

doi : https://doi.org/10.7180/kmj.2017.32.2.251

Seong Woon Yoon ¹, Jin-Sook Jeong ², Su Young Kim ³, Sung Wook Lee^,³, Seun Ja Park ⁴

¹Department of Internal Medicine, Daedong Hospital, Busan, Korea

²Division of Pathology, Dong-A University College Of Medicine, Busan, Korea

³Division of Gastroenterology and Hepatology, Dong-A University College of Medicine, Busan, Korea

⁴Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Corresponding Author: Sung wook Lee, Division of Gastroenterology and Hepatology, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2983 Fax: +82-51-240-2087 E-mail: sunglee@dau.ac.kr

Received 2016 May 19; 2016 May 30; Accepted 2016 May 25.

Abstract

Radiofrequency ablation (RFA), a local ablative modality, is gaining acceptance for the treatment of liver malignancies. Despite a relatively low complication rate, tumor seeding resulting from RFA in hepatocellular carcinoma (HCC) treatment can occur. A 44-year-old woman was diagnosed with HCC. Spiral computed tomography (CT) revealed a 2.3 × 2.0-cm mass in the S5 segment, which was treated with RFA on May, 2005. Follow-up imaging, performed at 6-month intervals after RFA, showed complete tumor necrosis. In October 2009, CT revealed a heterogeneous mass, 5.7 cm in diameter, in the right ovary. Since the lesion was limited to the right ovary without evidence of spread, bilateral salpingo-oophorectomy was performed. Histopathology indicated that the metastatic spread from the HCC to the ovary was positive for hepatocyte-specific antigen on immunohistochemistry. The ovary is a rare site for HCC metastasis. Moreover, needle tract implantation of HCC in the ovary is very rare.

Keywords: Hepatocellular carcinoma; Metastasis; Neoplasm seeding; Radiofrequency ablation

Fig. 1.

(A) Abdominopelvic computed tomography (CT) shows a low- density 2.3 cm mass (before radiofrequency ablation (RFA). (B) low-density lesion on the portal phase in S5 of the liver (post RFA). (C) Abdominopelvic CT reveals a 5.7 cm heterogeneous mass. (D) T2-weighted magnetic resonance image shows a high signal intensity mass in right ovary.

Fig. 1.

(A) Tissue from ovarian mass (Hematoxylin and Eosin Staining (H-&E) stain, x2). The ovarian mass compose of fragmented ovarian cortex, and tumor mass with hemorrhage. (B) Mid-magnification (H&-E stain, x20). The ovarian mass is of hepatocellular carcinoma with hemorrhage. (Long arrow: HCC, short arrow: Ovary)

Fig. 3.

Higher magnification (A, H&-E; B, hepatocyte specific antigen immunohistochemistry (HSA); C, Carcinoembryonic Antigen immunohistochemistry (CEA), x200). (A) The hepatocellular carcinoma metastatic to vary shows thick trabecular and occasionally pseudo glandular architecture, clear cell type and nuclear grade 2/3 (common/worst). (B) Representing clear HAS (+) and (C) bile canalicular type of CEA.

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