A case of hepatocellular carcinoma of the caudate lobe relapsing with variable patterns after hepatectomy

A 61-year-old man was referred for evaluation of positive HBs-Ag and an unusually high level (28,396 ng/mL) of serum alpha-fetoprotein in serum. Computed tomography of the abdomen revealed a huge extrahepatically growing tumor which was originating from the caudate lobe and extended to the posterior segment of the right lobe of the liver and encircled the anterior half of inferior vena cava. Biochemical examination showed a good liver function with 8% of ICG R15 and 103% of prothrombin time. Total resection of the caudate lobe with posterior segmentectomy was performed. Relapsing tumors, which metastasized to the liver in 9 months, the right lung in 15 months and the left lung in 20 months after initial surgery, were totally resected, respectively. Radiation therapy was effective to mediastinal lymph nodes metastasized in 25 months after the initial surgery. He survived with good quality of life for 46 months until he died from brain metastasis. Therefore, the multidisplinary therapy combined with radiation and surgery for hepatocellular carcinoma of the caudate lobe may have improved a long-term survival.