To explore the clinical diagnosis method of multiple primary malignancies (MPM) complicated with hepatocellular carcinoma (HCC).

Clinical data of 68 MPM patients complicated with HCC treated in the Sun Yat-sen University Cancer Center from January 1989 to April 2008 were retrospectively analyzed. There were 61 males and 7 females, aged from 32 to 82 years with a median age of 60 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients undergoing no surgery were diagnosed by imaging examination combined with detection of serum AFP level. Ultrasound- or CT-guided pathological biopsy was performed further on the suspected cases. The diagnosis was confirmed by pathological examination in patients undergoing surgery.

Of the 68 patients, 22 complicated with HCC simultaneously and 46 metachronously. The age of the first onset of malignancy ranged from 31 to 76 years with a median age of 57 years. The age of onset of secondary malignancy ranged from 32 to 82 years with a median age of 60 years. Hepatitis B surface antigen (HBsAg) was detected in 45 patients, whereas hepatitis C antibody was negative in all cases. Fifty-one cases were complicated with liver cirrhosis. AFP≤ 25 g/L was detected in 30 cases and >25 g/L in 38 cases. Sixteen cases had a family history of malignant tumors. Thirty of the 33 patients undergoing no surgery were confirmed based upon the typical HCC manifestations of imaging findings and AFP levels, including 16 cases were confirmed by positron emission computed tomography (PET/CT). The remaining 3 suspected cases were confirmed by ultrasound- or CT-guided liver biopsy. Thirty-five patients undergoing hepatic resection received pathological examination including 30 cases with single cancerous nodule and 5 with multiple cancerous nodules, 12 with tumor diameter<5 cm and 23 with tumor diameter≥5 cm. Twenty-seven patients were complicated with cirrhosis, 32 with vascular invasion, and 15 cases were found with surgical margin≥2 cm. Extrahepatic malignancies were distributed in different organs including head and neck tumors in 23 cases, digestive system tumors in 18 cases, urinary system tumors in 5 and other organ tumors in 22 cases.

The clinical characteristics of MPM complicated with HCC patients are similar to those of primary liver cancer patients. PET/CT probably possesses specific advantages in identifying MPM. Liver biopsy contributes to confirming the diagnosis of suspected cases.