A Case Report on a Large, Peduncular Intra-abdominal Hepatocellular Carcinoma Extending into the Retroperitoneum

Abstract Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis infection due to chronic inflammation and persistent cytokine release. Although rare, patients may present with large, pedunculated hepatocellular neoplasms that extend into the intra-abdominal space. Here, we present a case report on a 66-year-old male who was found to have such a mass that required careful pre-operative planning to complete a challenging, yet worthwhile, surgical intervention with R0 resection. Case Presentation A 66-year-old Caucasian male with a history of Hepatitis C presented with 4-5 months of abdominal pain, distention and weight loss. Imaging revealed a large heterogenous mass attached to the left lobe of the liver, with compression of the stomach, transverse colon and abdominal wall. Biopsy revealed hepatocellular carcinoma with extensive necrosis and ultimately the patient required surgical intervention, which required resection of omentum, partial gastrectomy, hepatectomy and extensive dissection of the mass to separate the tumor from the remaining intra-abdominal structures and the retroperitoneum. Conclusion Peduncular hepatocellular carcinomas vary in presentation and difficulty of resection. The prognosis and probability of successful surgical intervention depends on the level of differentiation, early staging, size of the neoplasm and invasion into surrounding structures. In this case, R0 resection was successfully performed.