Hepatocellular carcinoma in situs inversus totalis-a case report

  • Thuingaren Sareo Department of Radiotherapy, Regional Institute of Medical Sciences, Imphal - 795004, Manipur
  • Yumkhaibam S. Devi Department of Radiotherapy, Regional Institute of Medical Sciences, Imphal - 795004, Manipur
  • Laishram J. Singh Department of Radiotherapy, Regional Institute of Medical Sciences, Imphal - 795004, Manipur
Keywords: hepatocellular carcinoma, situs inversus totalis, case report
Abstract viewed: 837 times
PDF downloaded: 542 times


A 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray  postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week.

Keywords: hepatocellular carcinoma, situs inversus totalis, case report


  1. David LB, Adrian MD, Laura AD. Cancer of the liver. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 9th ed. Philadelphia: JB Lippincott; 2011. p. 997-1018.

  2. Kamiike W, Itakura T, Tanaka H, Hatanaka N, Nakamuro M, Miyata M, et al. Hepatic segmentectomy on primary liver cancer with situs inversus totalis. HPB Surg. 1996;9(3):169-72. http://dx.doi.org/10.1155/1996/29894

  3. Kanematsu T, Matsumata T, Kohno H, Sugimachi K, Inokuchi K. Hepatocellular carcinoma with situs inversus. Cancer. 1983;51(3):549-52. http://dx.doi.org/10.1002/1097-0142(19830201)51:3<549::AID-CNCR2820510331>3.0.CO;2-F

  4. Brueckner M, D’Eustachio P, Horwich AL. Linkage mapping of a mouse gene, iv, that controls left-right asymmetry of the heart and viscera. Proc Natl Acad of Sci USA. 1989;86(13):5035-8. http://dx.doi.org/10.1073/pnas.86.13.5035

  5. Gedda L, Sciacca A, Brenci G, Villatico S, Bonanni G, Gueli N, et al. Situs viscerum specularis in monozygotic twins. Acta Genet Med Gemellol (Roma). 1984;33(1):81-5.

  6. Xu LB, Wang J, Liu C, Pang HW, Chen YJ, Ou QJ, et al. Staging systems for predicting survival of patients with hepatocellular carcinoma after surgery. World J Gastroenterol. 2010;16(41):5257-62. http://dx.doi.org/10.3748/wjg.v16.i41.5257

  7. Lee YC, Cohet C, Yang YC, Stayner L, Hashibe M, Straif K.. Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol. 2009;38(6):1497-511. http://dx.doi.org/10.1093/ije/dyp280

  8. Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer. 2008;122(1):155-64. http://dx.doi.org/10.1002/ijc.23033

  9. Morgan TR, Mandayam S, Jamal MM. Alcohol and hepatocellular carcinoma. Gastroenterology. 2004;127:S87-96. http://dx.doi.org/10.1053/j.gastro.2004.09.020

  10. Holzman D, Ott PM, Felix H. Diagnostic approach to primary ciliary dyskinesia: A review. Eur J pediatr. 2000;159(1-2):95-8. http://dx.doi.org/10.1007/PL00013813

  11. Gutgesell HP. Cardiac malposition and heterotaxy. In: Garson AG Jr. Fisher DJ, Neish SR, editors. Science and Practice of Pediatric Cardiology. Vol 2. 2nded. Baltimore: Williams & Wilkins; 1998. p. 1539-61.

  12. Higgins CB. Essentials of cardiac radiology and imaging. Philadelphia: JB Lippincott; 1992. p. 283-331.

  13. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245-55. http://dx.doi.org/10.1016/S0140-6736(11)61347-0

  14. Harada T, Shigeta K, Noda K, Fukumoto Y, Nishimura H, Mizuta M, et al. Clinical implications of alpha-fetoprotein in liver cirrhosis: five-year follow-up study. Hepatogastroenterology. 1980;27(3):169-75.

  15. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109-22. http://dx.doi.org/10.1016/0360-3016(91)90171-Y

  16. Lawrence TS, Robertson JM, Anscher MS, Jirtle RL, Ensminger WD, Fajardo LF. Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys. 1995;31(5):1237-48. http://dx.doi.org/10.1016/0360-3016(94)00418-K

  17. Zeng ZC, Tang ZY, Fan J, Qin LX, Ye SL, Zhou J, et al. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys. 2005;63(4):1067-76. http://dx.doi.org/10.1016/j.ijrobp.2005.03.058

  18. Kaizu T1, Karasawa K, Tanaka Y, Matuda T, Kurosaki H, Tanaka S, et al. Radiotherapy for osseous metastases from hepatocellular carcinoma: a retrospective study of 57 patients. Am J Gastroenterol. 1998;93(11):2167-71. http://dx.doi.org/10.1111/j.1572-0241.1998.00614.x

  19. Tunc B, Filik L, Tezer-Filik I, Sahin B. Brain metastasis of hepatocellular carcinoma: a case report and review of the literature. World J Gastroenterol. 2004;10(11):1688-9.

  20. Salhab M, Canelo R. An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther. 2011;7(4):463-75. http://dx.doi.org/10.4103/0973-1482.92023

How to Cite
Sareo T, Devi YS, Singh LJ. Hepatocellular carcinoma in situs inversus totalis-a case report. Med J Indones [Internet]. 2014Mar.11 [cited 2022Oct.1];23(1):48-1. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/690
Case Report/Series