peritoneal dissemination of hepatocellular carcinoma ( hcc ) occurs rarely and is usually considered a terminal stage . dissemination of hcc was shown along the needle biopsy tract to the abdominal wall and by rupture of hcc and as the consequence of cancer peritonitis by tumor recurrence . it should be considered that needle biopsy of the liver tumor can lead to dissemination to the abdominal wall . rupture of hcc is fatal and needs emergent treatment , as tumor cells seed into the peritoneal cavity . cancer peritonitis was shown in most cases with dissemination of hcc . however , dissemination of hcc without cancer peritonitis to the peritoneum apart from a primary tumor has not been reported . in our case , the primary tumor was not ruptured and we had not performed needle biopsy of the liver tumor . under these circumstances , we diagnosed the liver tumor as hcc based on elevation of tumor markers such as alpha - fetoprotein ( afp ) and protein induced by vitamin k absence or antagonist - ii ( pivka - ii ) . we report a case of peritoneal dissemination of hcc in which operation improved the patient 's quality of life . peritoneal dissemination is a rare presentation of hcc , and we should thus examine the characteristics of further cases . a 74-year - old man was admitted to our hospital because he had palpated a mass in the right lower quadrant region . laboratory data were zinc sulfate turbidity test 19.2 ku , thymol turbidity test 10.8 ku , afp 86.6 ng / ml and pivka - ii 44.3 g / ml . hbs antigen and hcv antibody were negative . ultrasonography showed a 3.5  2.6 cm high - echoic mass in the medial segment of the liver ( fig . 1 ) . enhanced computed tomography revealed a low - density area 3 cm in diameter in the same lesion and a giant well - defined mass , 5  10 cm in size , continuing from the diaphragm to left kidney between the stomach and spleen ( fig . 2 ) . angiography showed a hypervascular tumor in the medial segment of the liver . fluoroscopy showed a tortuous lesion from the fundus to the superior of body of the stomach . endoscopic retrograde cholangiopancreatography did not detect abnormal findings . laparotomy did not reveal ascites or blood in the peritoneal cavity . in the medial segment of the liver , there was a 3  3 cm tumor evaginated to the diaphragm . there were another 5  5 cm tumor evaginated from left diaphragm and a 7  7 cm tumor at the hilum of the spleen . both tumors were not continuous and separated . then we performed partial hepatectomy and resected the tumor of the diaphragm , the tumor of the hilum of the spleen with tail of the pancreas and spleen , and the tumor of the greater omentum . , 2 years after the surgery , the patient remains alive without any evidence of recurrence . peritoneal dissemination of hcc is rare and has been observed rarely in surgical patients . as a consequence of needle biopsy or rupture of the primary tumor , peritoneal dissemination is essentially limited to the late stage of hcc [ 1 , 2 , 3 , 4 ] . in our case , the primary liver tumor was not ruptured and we had not performed needle biopsy . thus , our case is very rare . surgical treatment has been felt to be of little value in improving survival . despite recent advances in the diagnosis and surgical management of hcc , no effective treatment for late - stage peritoneal metastases has been developed . occasionally , systemic chemotherapy was effective in cases of peritoneal dissemination of hcc . miyake et al .   reported a case who developed peritoneal dissemination of hcc after hepatectomy , in whom marked tumor regression was found with a combination therapy of interferon - alpha-2b and oral tegafur / uracil . there are some reports contributing to a patient 's life prognosis by surgical treatment [ 6 , 7 , 8 ] . in this case , we believe that resection of peritoneal dissemination prolonged survival with a good quality of life . peritoneal dissemination is a rare presentation of hcc , with a reported incidence of 216% in autopsy or laparoscopy cases . nakashima et al .   reported intraperitoneal dissemination such as diaphragm , douglas pouch , pancreas , spleen and gallbladder . moreover , the rate of peritoneal dissemination of hcc was considered to be higher in cases with liver cirrhosis compared to no liver cirrhosis . the mechanism of peritoneal dissemination from hcc was thought to be a rupture of exophytic hcc into the peritoneal cavity and subsequent seeding of metastatic deposits [ 10 , 11 ] . however , yeh et al .   reported that only 4 ( 25% ) of 16 patients had peritoneal dissemination from preexisting ruptured hcc . histopathologically , peritoneal dissemination of hcc is considered to be undifferentiated or poorly differentiated type . in our case , the primary lesion was a 3  3 cm tumor and an unruptured hcc , and all of the resected tumors were of well - differentiated type and steatosis . yeh et al .   revealed that the afp values of patients developing peritoneal dissemination from hcc after hepatectomy were high ( mean 3,311.3 ng / ml ) . tumor markers such as afp played an important role in indicating the presence of peritoneal dissemination from hcc . furthermore , yeh and chen   reported that a high afp level and capsular invasion by the tumor cells may predispose posthepatectomy patients to peritoneal implantation from their hccs . in conclusion , even when disseminated hcc is found , surgical treatment should be considered for selected patients , provided that the lesions are discretely located .