{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:42:33Z","timestamp":1790023353160,"version":"4.0.1"},"reference-count":23,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hepatoid carcinoma of the ovary (HCO) is a tumor that resembles, both histologically and cytologically, hepatocarcinoma (HCC) in a patient with a non-cirrhotic liver not involved by the disease. Hepatoid carcinoma is an extremely rare histologic subtype of ovarian cancer and should be distinguished from metastatic HCC. Here, we report the rare case of a 67-year-old woman with ovarian recurrence of HCC 12 years after first diagnosis. The patient was being followed by oncologists because she had been diagnosed with HCV-related HCC (Edmonson and Stainer grade 2, pT2 N0 M0, G2, V1) in 2009. She had undergone surgery for enlarged left hepatectomy to the 4th hepatic segment with cholecystectomy and subsequent placement of a Kehr drain. The preoperative alpha-fetoprotein (AFP) level was 8600 ng\/mL, while the postoperative value was only 2.7 ng\/mL. At the first diagnosis, no other localizations of the disease, including the genital tract, were found. At the time of recurrence, however, the patient was completely asymptomatic: her liver function was within normal limits with negative blood indices, except for an increased blood dosage of AFP (467 ng\/mL), and CA125, which became borderline (37.4 IU\/mL). The oncologist placed an indication for a thoracic abdominal CT scan, which showed that the residual liver was free of disease, and the presence of a formation with a solid\u2013cystic appearance and some calcifications at the left adnexal site. The radiological findings were confirmed on level II gynecological ultrasound. The patient then underwent a radical surgery of hysterectomy, bilateral oophorectomy, pelvic peritonectomy, and omentectomy by a laparotomic approach, with the sending of intraoperative extemporaneous histological examination on the annexus site of the tumor mass, obtaining RT = 0. Currently, the patient continues her gyneco-oncology follow-up simultaneously clinically, in laboratory, and instrumentally every 4 months. Our study currently represents the longest elapsed time interval between first diagnosis and disease recurrence, as evidenced by current data in the literature. This was a rather unique and difficult clinical case because of the rarity of the disease, the lack of scientific evidence, and the difficulty in differentiating the primary hepatoid phenotype of the ovary from an ovarian metastasis of HCC. Several multidisciplinary meetings for proper interpretation of clinical and anamnestic data, with the aid of immunohistochemistry (IHC) on histological slides were essential for case management.<\/jats:p>","DOI":"10.3390\/jcm12072468","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T02:34:54Z","timestamp":1679625294000},"page":"2468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Rare Case of Hepatocellular Carcinoma Recurrence in Ovarian Site after 12 Years Mimicking a Hepatoid Adenocarcinoma: Case Report"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-0329","authenticated-orcid":false,"given":"Stefano","family":"Restaino","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Pellecchia","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n\u00b0 50, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8098-9204","authenticated-orcid":false,"given":"Alice","family":"Poli","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n\u00b0 50, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-0618","authenticated-orcid":false,"given":"Martina","family":"Arcieri","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"},{"name":"Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Andreetta","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)\u2014Ospedale S. Maria della Misericordia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1243-8398","authenticated-orcid":false,"given":"Laura","family":"Mariuzzi","sequence":"additional","affiliation":[{"name":"Medical Area Department, Institute of Pathological Anatomy, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Orsaria","sequence":"additional","affiliation":[{"name":"Medical Area Department, Institute of Pathological Anatomy, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Biasioli","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Della Martina","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Giuseppe","family":"Intini","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Academic Hospital of Udine, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Scambia","sequence":"additional","affiliation":[{"name":"Institute of Gynaecology and Obstetrics Clinic, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Driul","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"},{"name":"Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n\u00b0 50, 33100 Udine, Italy"},{"name":"Department of Medical Area (DAME), University of Udine, Azienda Ospedaliera Universitaria Friuli Centrale, ASUFC, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2424-2691","authenticated-orcid":false,"given":"Giuseppe","family":"Vizzielli","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n\u00b015, 33100 Udine, Italy"},{"name":"Gynecology and Obstetrics Clinic, Department of Medicine, University of Udine, Via Colugna n\u00b0 50, 33100 Udine, Italy"},{"name":"Department of Medical Area (DAME), University of Udine, Azienda Ospedaliera Universitaria Friuli Centrale, ASUFC, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.1002\/1097-0142(19871201)60:11<2775::AID-CNCR2820601130>3.0.CO;2-S","article-title":"Hepatoid carcinoma of the ovary. 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