BMJ Case Reports 2018; doi:10.1136/bcr-2017-222514
  • Global health

Ruptured hepatocellular carcinoma disguising as heterotopic pregnancy

  1. Mahsa Seyed Ahadi3
  1. 1Medicine, University of New South Wales (UNSW), Albury, New South Wales, Australia
  2. 2Emergency, Albury Wodonga Health, Albury Campus, Albury, New South Wales, Australia
  3. 3Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  1. Correspondence to Gabriel Ayonmigbesimi Akra, akragbesimi{at}
  • Accepted 6 February 2018
  • Published 27 February 2018


The incidence of hepatocellular carcinoma (HCC) in pregnancy is rare but is typically aggressive, with a 1-year survival rate of 23%. One of the complications of HCC is spontaneous rupture, resulting in haemoperitoneum. A 36-year-old pregnant Chinese immigrant who was positive for hepatitis B virus and in her first trimester presented to the emergency department of Wyong Hospital, Hamlyn Terrace, New South Wales, Australia, with severe epigastric and right upper quadrant pain and haemodynamic instability. Spontaneous rupture of a heterotopic pregnancy was initially suspected. However, histopathological staining of the lesions excised during surgery revealed HCC. To our knowledge, this is the first case of spontaneous rupture of HCC with haemoperitoneum during pregnancy in Australia. As developed countries receive global migrants, similar cases may be seen in the future. Epidemiological studies suggest that immigrants from China and Vietnam have the highest incidence of chronic hepatitis B virus carrier status.


  • Contributors QNL and GAA wrote the manuscript. AGK reviewed the manuscript with expert advice. MSA wrote the pathology report. All authors reviewed the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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