The patient was a 62-year-old man with no specific medical history. Lateral
segmentectomy was performed for
hepatocellular carcinoma with a
tumor size of approximately 14×13 cm. The histopathological diagnosis was moderately differentiated
hepatocellular carcinoma: Fc(-), Fc-Inf(-), Sf(-), S0, N0, Vp2, Vv1, Va0, B0, P0, SM(-), CH. Five years after the first surgery, computed tomography(CT)revealed a left lung
tumor in segment 9/10 and left lymph nodes; thus, left
pneumonectomy was performed, and these
tumors were identified to have metastasized from the primary
tumor. Six years after the first surgery, his serum
alpha-fetoprotein level was remarkably elevated from 254.9 ng/mL to 3,143.0 ng/mL for three months, and at the same time, he developed left meralgia and swelling of the left femur. Magnetic resonance imaging showed a high-density mass(30×14 cm)in the left quadriceps, and positron emission tomography-CT revealed high uptake in the left quadriceps with a maximum standardized uptake value of 12.3. A needle biopsy of the left femur
tumor confirmed
metastasis from the primary
tumor.
Radiotherapy was administered because
general anesthesia can prove to be hazardous due to the patient having undergone left
pneumonectomy.