Diaphragmatic and subcutaneous seeding of hepatocellular carcinoma following fine‐needle aspiration biopsy

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Abstract
— Aims/Background: We report the discovery of associated metastatic subcutaneous and metastatic diaphragmatic nodules on the needle track after fine‐needle biopsy aspiration under echography, which has not yet been reported in the literature. Methods: A 35‐year‐old man with non‐replicating hepatitis B virus presented with a tumor that suggested hepatocarcinoma with cirrhosis. A diagnostic needle biopsy was carried out before surgery. Twelve months later, he presented with a series of four continuous metastatic diaphragmatic nodules on the inner wall lining the needle track. Surgery was performed, followed by external radiation (40 Gy). Conclusions: The risk of seeding following fine‐needle biopsy aspiration of hepatocellular carcinoma can no longer be considered negligable. The real risk is probably underestimated. Even for biopsy of lesions localized to the inferior part of the liver, diaphragmatic seeding is possible. This seeding necessitates surgical resection, increasing the therapeutic morbidity of hepatocellular carcinomas. We believe that in cases where investigation of a small hepatic tumor suggests a hepatocellular carcinoma that could be resected, or for candidate patients for liver transplantation, one should not puncture the tumor. If this diagnostic biopsy is essential, then the needle track could be resected upon surgery, after cutaneous external tattooing.