title: Laparoscopic resection of recurrent ectopic hepatocellular carcinoma: A case report with review of the literature and guidelines for follow-up.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) in ectopic liver tissue is extremely rare.
  
  
  METHODS
  A 64-year-old woman presented initially with abdominal complaints. Computed tomography (CT) revealed a tumor in the diaphragm and laparoscopic resection of the tumor was performed. Histology showed HCC. During the next 4 years four more tumors, all of which showed HCC on histology and were located extrahepatically, was treated with laparoscopic resection. During this course the patient was followed with regular thoracoabdominal CT and measurement of serum alpha-fetoprotein (AFP). A negative magnetic resonance imaging (MRI) examination of the liver excluded a primary intrahepatic tumor.
  
  
  CONCLUSIONS
  The literature available on ectopic HCC and the guidelines for management of HCC do not address the postoperative surveillance of patients undergoing curative treatment. A follow-up regime has been proposed by Hatzaras et al. (2014) to include cross-sectional imaging of the liver and measurement of serum AFP levels [1]. CT would be the preferred study of choice in a total radiologic investigation of the abdomen. While MRI is prone to artifacts due to movements, CT scans allows so rapid recordings that this no longer is an issue. An early investigation of the liver for intrahepatic HCC should nevertheless be performed early to exclude primary intrahepatic HCC.
  
  
  CONCLUSIONS
  We recommend that patients with ectopic HCC should be followed every 6 months with measurement of AFP and abdominal CT imaging. MRI of the liver should be performed early to exclude primary intrahepatic HCC.
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Arne Marino
authors.initials: AM
authors.lastname: Aarås
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: trulsagjersoe@gmail.com.
authors.forename: Truls André
authors.initials: TA
authors.lastname: Reitan-Gjersøe
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Waage
authors.affiliation: Department of Gastrointestinal Surgery, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Mala
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; The Interventional Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Edwin
authors.affiliation: Department of Pathology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.
authors.forename: Else Marit
authors.initials: EM
authors.lastname: Løberg
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
authors.forename: Andreas
authors.initials: A
authors.lastname: Abildgaard
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
authors.forename: Bård Ingvald
authors.initials: BI
authors.lastname: Røsok
keywords: Carcinoma; Ectopic; Follow-up; Hepatocellular; Laparoscopic; Resection