title: Successful en bloc resection of recurrent hepatocellular carcinoma directly invading the abdominal wall: a case report.
abstract: BACKGROUND
  Repeat hepatic resection has previously been reported as the most effective treatment for recurrence of intrahepatic carcinoma. To the best of our knowledge, en bloc resection of recurrent hepatocellular carcinoma directly invading the abdominal wall has not been previously reported.
  
  
  METHODS
  In September 2012, a 64-year-old Chinese male patient was referred to our hospital because of primary hepatocellular carcinoma located in Couinaud's segments III and V. Our patient first had a hepatectomy of the liver. Ten months later, he presented with an abdominal wall mass and upper abdominal pain. Computed tomography and magnetic resonance imaging scans demonstrated a 10cm tumor in his left liver with extrahepatic metastases in his abdominal wall. It was determined that he had recurrent hepatocellular carcinoma associated with direct invasion into his abdominal wall. He had an en bloc left hepatectomy with resection of the tumor in his abdominal wall. A pathological examination of the resected specimen confirmed the diagnosis of hepatocellular carcinoma involving the abdominal wall. Disease-free margins of resection were achieved. Our patient's postoperative course was uneventful. Eight months after the last surgery, our patient died owing to recurrence and distal metastasis.
  
  
  CONCLUSIONS
  Direct invasion of hepatocellular carcinoma into the abdominal wall is rarely encountered. Complete surgical resection should be considered in patients with an appropriate hepatic functional reserve, with consideration of the technical difficulty relating to tumor involvement with surrounding tissues.
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China. ajli62@gmail.com.
authors.forename: Aijun
authors.initials: A
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Longjiu
authors.initials: L
authors.lastname: Cui
authors.forename: Mengchao
authors.initials: M
authors.lastname: Wu
mesh_terms: D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D017809:Fatal Outcome; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D014057:Tomography, X-Ray Computed