Cancer J 2007, 13:168–174.PubMedCrossRef Competing interests The authors declare that they have no competing interest. Authors’ contribution PV: data collection, analysis and conclusions; TW, AC, CB: data collection and processing, FH: study design, paper review. All authors read and approved the final manuscript.”
“Introduction Hepatocellular carcinoma (HCC) is the fifth

most common type of cancer diagnosed worldwide and the third leading cause of cancer-related mortality [1, 2]. Spontaneous rupture is reported to occur in 3 – 15% of cases and is one of the most severe complications of HCC [3–5]. The prognosis for spontaneous rupture of HCC is poor, with a hospital mortality rate ranging from 33 to 67% [6–8]. However, clinical diagnosis of this HCC complication is difficult due to its atypical symptoms. #MRT67307 mouse randurls[1|1|,|CHEM1|]# For example, some patients may present with abdominal pain, abdominal distension and anemia, while others suffer from shock as the initial symptom. Furthermore, treatment of HCC is complicated by co-morbidities, coagulopathy, hemorrhagic shock, liver cirrhosis, and decreased Selleckchem SB-715992 liver function. A peripherally located large HCC lesion is clinically prone to grossly involve the diaphragm, either by dense adhesion or as a result of histological invasion

[9]. According to autopsy studies, direct diaphragmatic involvement is found in 10%–13% of patients with HCC [10], and in such cases, en bloc resection of the diaphragm seems appropriate. Fludarabine molecular weight However, such extensive surgery was thought to present too high a risk of damage

during the postoperative course. This case study looks at a previously undiagnosed patient with a spontaneously ruptured HCC in triangular ligament with diaphragm invasion. Case report A 58-year-old man visited the emergency department with hypovolemic shock. His chief complaint was the sudden onset of epigastric pain with abdominal distension lasting 6 h. Physical examination revealed an ill appearance with a blood pressure of 60/40 mmHg and a pulse rate of 132/min. Conjunctiva were pale but not icteric. Breath sounds were clear, and heart sounds were regular and without murmurs. The patient had negative history of hepatitis B, hepatitis C or trauma. Hemoglobin was 6.9 g/dl, white blood count was 15,800/mm3 and platelet count was 176,000/mm3. Liver function tests were within the normal range [serum alanine transaminase 35 IU/l (normal: 5–40 IU/l), serum aspartate transaminase 18 IU/l (normal: 8–40 IU/l), gamma glutamyltranspeptidase 16 IU/l (normal:<30 IU/l), alkaline phosphatase 38 IU/l, total billibubin 0.6 mg/dl, direct billibubin 0.3 mg/dl]. Prothrombin time and International Normalized Ratio (INR) were prolonged with prothrombin time of 16.4 s (normal: 10.2 – 13.6), and INR of 1.43 (PT ratio). Abdominal contrast enhanced CT imaging revealed a mass invading the diaphragm with contrast extravasation in the left, lateral segment of the liver (Figure  1, and Figure  2).