Open Access

CASE REPORT

A Rare Case of Atraumatic Splenic Rupture Due to Metastatic Hepatocellular Carcinoma

Dang Quang Hung^1,#, Nguyen-Thi Nhan¹, Trinh-Thi Phuong Nga¹, Nguyen Thanh Hai¹, Nguyen Quang Duc¹, Nguyen Viet Thu¹, Nguyen Truong Duc¹, Dinh-Van Thuyet¹, Nguyen Minh Duc^2,#,*,ORCID
1 Department of Radiology, Vinmec Healthcare System, Ha Noi, Viet Nam
2 Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
* Corresponding Author: Nguyen Minh Duc. Email: bsnguyenminhduc@pnt.edu.vn
# These authors contributed equally to this article as co-first authors
ORCID ID: 0000-0001-5411-1492

Oncologie https://doi.org/ 10.32604/oncologie.2021.019519

Received 27 September 2021; Accepted 13 October 2021; Published online 30 November 2021

Abstract

Metastatic spread of hepatocellular carcinoma (HCC) to the spleen is uncommon, only occurring in approximately 1% of cases. Atraumatic splenic rupture due to HCC metastasis is extremely rare and affects patient prognosis, clinical management, and mortality. We report a case of a 65-year-old man with a history of chronic hepatitis B infection who presented with left-sided abdominal pain and fatigue. Clinical examination showed acute anemia with elevated levels of serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence (PIVKA-II). On ultrasound and computed tomography imaging, hemoperitoneum caused by a ruptured splenic tumor was revealed. In addition to multiple hepatic lesions, enlarged abdominal lymph nodes and osteolytic lesions in the thoracic vertebral bodies were detected. The patient underwent total splenectomy and was diagnosed histopathologically with splenic rupture secondary to Grade 2 HCC metastasis. Atraumatic, pathological splenic rupture due to HCC metastasis should be considered in patients with chronic hepatitis B or C infection and increasing serum AFP and PIVKA-II levels, even though splenic metastasis is uncommon.

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Keywords

Atraumatic splenic rupture; hepatocellular carcinoma; splenic metastases

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