A case report on Hepatocellular Carcinoma with inferior vena cava and right atrium tumor thrombus in a patient with COVID-19 infection.
- Author:
Mark Paolo M. Chatto
1
;
Angelo B. Lozada
1
Author Information
1. Makati Medical Center
- Publication Type:Case Reports
- From:
Journal of the Philippine Medical Association
2023;101(2):39-44
- CountryPhilippines
- Language:English
-
Abstract:
BACKGROUND:Hepatocellular carcinoma (HCC) is the fourth most
common cancer in the Philippines and is the second
leading cause of cancer-related death due to advanced
stage at diagnosis in many patients. Advanced HCC
commonly has macrovascular invasion such as portal
and hepatic veins however, cases that describe
tumor extension into the inferior vena cava (IVC) and
right atrium (RA) are rare.
CASE SUMMARY:We present a case of a 50-year old female with liver
cirrhosis from Chronic Hepatitis B infection who
presented with shortness of breath. She was diagnosed
with HCC based on dynamic enhancement pattern on
CT scan with IV contrast and highly elevated alpha-
fetoprotein. CT imaging demonstrated hepatic vein
invasion with large tumor thrombus extending to the
inferior vena cava and right atrium. Patient also had
a mild COVID infection. We treated her with
modulated radiotherapy targeting the tumor thrombus
along with lenvatinib, tenofovir, and apixaban. The
COVID infection did not significantly affect the patient's
over-all clinical status.
CONCLUSION:Vascular invasion of HCC into the IVC and RA portends
poor prognosis. While there is no consensus on the
intervention on these patients, our case may suggest the
use of radiotherapy and oral anticoagulation along with
lenvatinib to prolong survival and preserve quality of life.
- Full text:101(2)_7.pdf
