Drop metastasis from hepatocellular carcinoma after percutaneous radiofrequency ablation therapy

For treating hepatocellular carcinoma (HCC), radiofrequency ablation (RFA), a nonsurgical locoregional therapy, is frequently chosen as the first treatment modality because it is effective and less invasive, with preservation of the remnant hepatic parenchyma. Tumor implantation along needle tract or on other sites is a rare complication of RFA. We present a patient with HCC who developed a drop metastasis into the peritoneal cavity. A 62-year-old male cirrhotic patient with hepatitis B was diagnosed with HCC. On the computed tomography (CT) scan, a 2-cm solitary tumor was found in hepatic segment VII, compatible with HCC (Fig. 1A). Laboratory findings showed an elevated protein induced by vitamin K absence/antagonist-II (PIVKA-II) level (586 mAU/mL), with a normal α-fetoprotein level. The patient was treated with percutaneous RFA. Artificial ascites was created for better visualization of the tumor. The treatment was successful, with complete necrosis of the tumor (Fig. 1B). Twelve months later, a 6-cm lobulated heterogeneous highly enhancing mass was found on the anterior aspect of the Drop metastasis from hepatocellular carcinoma after percutaneous radiofrequency ablation therapy