At present, there is no uniform standard for diagnosis and treatment of portal hypertension complicated with hepatocellular carcinoma internationally. Although in recent years, with the significant advances of surgical technique and the positive progress of targeted and immunotherapy in the field of hepatocellular carcinoma, the survival of hepatocellular carcinoma patients has improved, but the risk of surgery in patients with portal hypertension complicated with hepatocellular carcinoma remains high, and surgical treatment is still controversial. Therefore, based on the existing evidence, the Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association has organized relevant experts to develop the consensus on clinical diagnosis and treatment of portal hypertension with hepatocellular carcinoma (2022) after full discussion. This consensus aims to provide the latest guidance for the standardized diagnosis and treatment of portal hypertension with hepatocellular carcinoma in China. Given that most portal hypertension originates from cirrhosis, this consensus only addresses the diagnosis and treatment of cirrhosis-related portal hypertension with hepatocellular carcinoma.
Carcinoma, Hepatocellular/therapy* ; Consensus ; Humans ; Hypertension, Portal/therapy* ; Liver Cirrhosis/complications* ; Liver Neoplasms/therapy*

A liver transplantation is a treatment option in selected patients with hepatocellular carcinoma (HCC). Despite the adequate selection of candidates, recurrences of HCC may still develop. Solitary extrahepatic metastasis from HCC after a liver transplantation is rare. Here we report two cases of HCC demonstrated extrahepatic recurrence to the adrenal gland and spleen, respectively, within one year after a liver transplantation. Since the treatment of solitary extrahepatic metastasis from HCC after a liver transplantation is not standardized, surgical resection was performed. In the case of HCC adrenal metastasis, innumerable intrahepatic metastases were found two months after the adrenalectomy. And 16 months after adrenalectomy, the patient expired due to tumor progression and hepatic failure. In the case of HCC splenic metastasis, postoperative radiation therapy was performed. However, two recurrent HCC nodules were found 15 months after the splenectomy and received transarterial chemoembolization (TACE). And 29 month after the splenectomy, the patient also expired as same causes of former patient.
Aged ; Carcinoma, Hepatocellular/complications/*therapy ; Humans ; Liver Neoplasms/complications/*therapy ; *Liver Transplantation ; Male ; Middle Aged ; Neoplasm Metastasis/*diagnosis

A liver transplantation is a treatment option in selected patients with hepatocellular carcinoma (HCC). Despite the adequate selection of candidates, recurrences of HCC may still develop. Solitary extrahepatic metastasis from HCC after a liver transplantation is rare. Here we report two cases of HCC demonstrated extrahepatic recurrence to the adrenal gland and spleen, respectively, within one year after a liver transplantation. Since the treatment of solitary extrahepatic metastasis from HCC after a liver transplantation is not standardized, surgical resection was performed. In the case of HCC adrenal metastasis, innumerable intrahepatic metastases were found two months after the adrenalectomy. And 16 months after adrenalectomy, the patient expired due to tumor progression and hepatic failure. In the case of HCC splenic metastasis, postoperative radiation therapy was performed. However, two recurrent HCC nodules were found 15 months after the splenectomy and received transarterial chemoembolization (TACE). And 29 month after the splenectomy, the patient also expired as same causes of former patient.
Aged ; Carcinoma, Hepatocellular/complications/*therapy ; Humans ; Liver Neoplasms/complications/*therapy ; *Liver Transplantation ; Male ; Middle Aged ; Neoplasm Metastasis/*diagnosis

Radio-frequency ablation (RFA) is a curative treatment for hepatocellular carcinoma (HCC). Percutaneous RFA has been shown to be beneficial for patients with small renal cell carcinoma (RCC) lacking indications for resection. We experienced the case of a 53-year-old male who had conditions that suggested HCC, RCC, and alcoholic liver cirrhosis. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance image showed liver cirrhosis with 2.8 cm ill-defined mass in segment 2 of the liver and 1.9 cm hypervascular mass in the left kidney. These findings were compatible with the double primary cancers of HCC and RCC. Transarterial chemoembolization (TACE) was performed to treat the HCC. After the TACE, a focal lipiodol uptake defect was noticed on a follow up CT images and loco-regional treatment was recommended. Therefore, we performed RFAs to treat HCC and RCC. There was no evidence of recurrence in the follow up image after 1 month.
Carcinoma, Hepatocellular/complications/*diagnosis/therapy ; Carcinoma, Renal Cell/complications/*diagnosis/therapy ; Catheter Ablation ; Humans ; Kidney Neoplasms/complications/*diagnosis/therapy ; Liver Cirrhosis/complications/*diagnosis ; Liver Neoplasms/complications/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Conventional radiation therapy (RT) is a widely recognized treatment for hepatocellular carcinoma (HCC). However, conventional RT plays only a limited role in HCC treatment because of its low efficacy and the low tolerance of the liver for this modality. Stereotactic body radiation therapy (SBRT) was recently developed and represents the most advanced radiation therapy technique currently available. It can deliver a high dose in a short time to well-defined hepatic tumors, with rapid dose fall-off gradients. We believe that SBRT with transarterial chemolipiodolization (TACL) may prove promising as a combined treatment modality for HCC due to its precision and relative safety. Here we present a case of successful treatment of advanced HCC with obstructive jaundice using this combined modality.
Carcinoma, Hepatocellular/complications/*therapy ; *Chemoembolization, Therapeutic ; Combined Modality Therapy ; Humans ; Jaundice, Obstructive/etiology/therapy ; Liver Neoplasms/complications/*therapy ; Male ; Middle Aged ; *Radiosurgery

No abstract available.
Adult ; Budd-Chiari Syndrome/complications/*pathology ; Carcinoma, Hepatocellular/complications/*pathology/therapy ; Humans ; Liver Neoplasms/complications/*pathology/therapy ; Liver Transplantation ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved.
Venous Thrombosis/*complications ; Portal Vein ; Middle Aged ; Male ; Liver Neoplasms/complications/radiography/*therapy ; Humans ; *Chemoembolization, Therapeutic ; Carcinoma, Hepatocellular/complications/radiography/*therapy

Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) or lymphatic/extrahepatic metastasis is classified as advanced stage (Stage C of Bacelona Clinic Liver Cancer Staging). There is few effective therapy for the advanced stage HCC, leading to an extremly poor prognosis. For these patients, Sorafinib is recommended as the only therapy by European and American guidelines, which has limited clinic effect. In China, besides Sorafinib, various therapies have also been suggested, including surgery, trans-arterial chemoembolization (TACE), radiotherapy, as well as traditional Chinese medicine. Recently, it is reported that several therapies may be effective in treating HCC with PVTT which is classified based on Cheng's classification, including surgery after "down-stage" radiotherapy, early use of sorafinib postoperatively, as well as postoperative antivirus treatment. The modified Folfox4 chemotherapy, is also a potential effective way to improve the prognosis of advanced stage HCC with lymphatic/extrahepatic metastasis. Mutiple disciplinary team which could faciliate the process of diagnosis and treatment of advanced stage HCC, is expected to favor the prognosis of these patients.
Carcinoma, Hepatocellular ; complications ; therapy ; Chemoembolization, Therapeutic ; China ; Humans ; Liver Neoplasms ; complications ; therapy ; Lymphatic Metastasis ; Portal Vein ; Prognosis ; Thrombosis ; complications ; Treatment Outcome

Haemochromatosis is characterised by elevated transferrin saturation (TSAT) and progressive iron loading that mainly affects the liver. Early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy and other complications. In patients homozygous for p.Cys282Tyr in HFE, provisional iron overload based on serum iron parameters (TSAT >45% and ferritin >200 μg/L in females and TSAT >50% and ferritin >300 μg/L in males and postmenopausal women) is sufficient to diagnose haemochromatosis. In patients with high TSAT and elevated ferritin but other HFE genotypes, diagnosis requires the presence of hepatic iron overload on MRI or liver biopsy. The stage of liver fibrosis and other end-organ damage should be carefully assessed at diagnosis because they determine disease management. Patients with advanced fibrosis should be included in a screening programme for hepatocellular carcinoma. Treatment targets for phlebotomy are ferritin <50 μg/L during the induction phase and <100 μg/L during the maintenance phase.
Male ; Humans ; Female ; Hemochromatosis/therapy* ; Hemochromatosis Protein/genetics* ; Carcinoma, Hepatocellular/complications* ; Iron Overload/genetics* ; Ferritins ; Liver Cirrhosis/complications* ; Iron ; Fibrosis ; Liver Neoplasms/complications* ; Transferrins

OBJECTIVETo evaluate the efficacy of transarterial embolization (TAE) for intraperitoneal hemorrhage due to spontaneous rupture in hepatocellular carcinoma (HCC).

METHODSFourty-two patients with ruptured HCC were divided into 4 groups according to the type of their previous treatment: Group A-TAE followed by elective hepatectomy 15, Group B- TAE alone 11, Group C-emergency operation 6 and group D-medical conservative management 10.

RESULTSCeliac arteriography done before the present treatment showed extravasation of contrast material in 7 (26.9%) of the 26 patients in group A and B, and hypervascular tumor was observed in the rest. The hemostasis success rate of group A, B and C were 100%, which were much higher than that of group D (40%) (P < 0.05). The in-hospital mortality rates of group A, B and C were 0, 3.8% and 16.7% (P > 0.05), which were much lower than that of group D (80%) (P < 0.01). The 1-year survival rate of group A (76.3%) was higher than those in groups B (47.5%) and C (43.7%) (P < 0.05). There was no 1-year survivor in group D.

CONCLUSIONTransarterial embolization is safe and effective for hemorrhage due to spontaneous rupture in hepatocellular carcinoma. For resectable lesions, TAE is a preferential treatment to be given first, then followed by elective hepatectomy.

Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; surgery ; Embolization, Therapeutic ; Female ; Hemorrhage ; etiology ; therapy ; Humans ; Liver Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Rupture, Spontaneous ; complications