Early stage of intraperitoneal rupture of hepatocellular Carcinoma: CT and MRI evaluation

The purpose of this study is to describe CT and MR findings of early stage intraperitoneal rupture of hepatocellular Carcinoma (hCC). Nine patients (5 men, 4 women), with known hCC, displayed suspicious CT findings of early intraperitoneal rupture during routine follow up. These included a local fluid collection creating dentation on tumor surface, mimicing capsular retraction. Six of the patients were further evaluated with MRI. Collection was aspirated and cytological analysis was positive for malignant cells in all cases. All patients were under chemotherapy for unresectable, large hCC’s, but none had ascites. They all died within a year for reasons uncelked to tumor rupture. In conclusion, we believe that this type of intraperitoneal rupture, which has never been proposed before, represents a local, extra-capsular extension of hCC, with micro-ruptures of liver capsule and local peritoneal infiltration and thickening that confine the collection locally preventing from massive intraperitoneal hemorrhage. The dentation of the tumor surface, in our opinion, represents pressure from the collection rather than true capsular retraction (“pseudo-retraction sign”). In conclusion, we believe that this type of rupture does not predispose to massive intraperitoneal hemorrhage and is a sign of advanced disease with poor prognosis.