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

A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.
Carcinoma, Hepatocellular/complications/radiography/*therapy ; *Chemoembolization, Therapeutic ; Drainage ; Gastric Fistula/*etiology ; Gastroscopy ; Hepatitis B/diagnosis ; Humans ; Liver Diseases/*etiology ; Liver Neoplasms/complications/radiography/*therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Stomach/pathology ; Tomography, X-Ray Computed

This is a case report of a 68-year-old man with hepatocellular carcinoma (HCC) accompanied by hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, and hepatic vascular malformation. HHT is an autosomal dominant disorder of the fibrovascular tissue that is characterized by recurrent epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations. HHT is caused by mutation of the genes involved in the signaling pathway of transforming growth factor-beta, which plays an important role in the formation of vascular endothelia1. Hepatic involvement has been reported as occurring in 30-73% of patients with HHT. However, symptomatic liver involvement is quite rare, and the representative clinical presentations of HHT in hepatic involvement are high-output heart failure, portal hypertension, nodular regenerative hyperplasia, and symptoms of biliary ischemia. Some cases of HCC in association with HHT have been reported, but are very rare. We present herein the characteristic radiologic and genetic findings of HHT that was diagnosed during the evaluation and treatment of HCC.
Activin Receptors, Type II/genetics ; Aged ; Angiography ; Carcinoma, Hepatocellular/*complications/*therapy ; Chemoembolization, Therapeutic ; Exons ; Gene Deletion ; Humans ; Liver Neoplasms/*complications/*therapy ; Male ; Mutation ; *Telangiectasia, Hereditary Hemorrhagic/complications/genetics/pathology/radiography ; Tomography, X-Ray Computed

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare. We report a case of 67-year-old man having HBV-associated HCC with multiple lung metastases which regressed spontaneously. The patient had single liver mass and received surgical resection. The mass was confirmed as HCC histopathologically. Nine years after surgical resection, a 3.3 cm sized recurred HCC was detected on the resection margin in CT scan. Transarterial chemoembolization (TACE) was performed 3 times, and lung metastases developed thereafter. The patient received 2 more sessions of TACE, however, metastatic lung nodules were in progress very rapidly. We decided to stop TACE and followed the patient regularly without any anti-cancer treatment. Nine months after development of lung metastasis, the size and number of metastatic lung nodules decreased and were not detected anymore after 14 months. Serum alpha-fetoprotein levels also decreased to normal range and no viable tumor was noted in the liver. The patient is still alive 12 years after the first diagnosis of HCC and 16 months after lung metastasis developed.
Aged ; Carcinoma, Hepatocellular/*pathology/secondary/therapy ; Chemoembolization, Therapeutic ; Hepatitis B, Chronic/complications/diagnosis ; Humans ; Liver Neoplasms/complications/*pathology/therapy ; Lung Neoplasms/*diagnosis/radiography/secondary ; Male ; Neoplasm Regression, Spontaneous ; Neoplasm Staging ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

BACKGROUND/AIMS: The goal of this study was to estimate the growth rate of hepatocellular carcinoma (HCC) and identify the host factors that significantly affect this rate. METHODS: Patients with early-stage HCC (n=175) who underwent two or more serial dynamic imaging studies without any anticancer treatment at two tertiary care hospitals in Korea were identified. For each patient, the tumor volume doubling time (TVDT) of HCC was calculated by comparing tumor volumes between serial imaging studies. Clinical and laboratory data were obtained from the medical records of the patients. RESULTS: The median TVDT was 85.7 days, with a range of 11 to 851.2 days. Multiple linear regression revealed that the initial tumor diameter (a tumor factor) and the etiology of chronic liver disease (a host factor) were significantly associated with the TVDT. The TVDT was shorter when the initial tumor diameter was smaller, and was shorter in HCC related to hepatitis B virus (HBV) infection than in HCC related to hepatitis C virus (HCV) infection (median, 76.8 days vs. 137.2 days; P=0.0234). CONCLUSIONS: The etiology of chronic liver disease is a host factor that may significantly affect the growth rate of early-stage HCC, since HBV-associated HCC grows faster than HCV-associated HCC.
Adult ; Aged ; Aged, 80 and over ; Antiviral Agents/therapeutic use ; Carcinoma, Hepatocellular/complications/*pathology/radiography ; Demography ; Female ; Hepatitis B, Chronic/*complications/drug therapy ; Hepatitis C, Chronic/*complications/drug therapy ; Humans ; Linear Models ; Liver Neoplasms/complications/*pathology/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed

OBJECTIVE: To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). MATERIALS AND METHODS: Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. RESULTS: Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. CONCLUSION: RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.
Aged ; Antibiotics, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/*drug therapy/radiography/*surgery/ultrasonography ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Combined Modality Therapy ; Disease Progression ; Doxorubicin/administration & dosage ; Ethiodized Oil/administration & dosage ; Feasibility Studies ; Female ; Fluoroscopy ; Humans ; Liver Neoplasms/*drug therapy/radiography/*surgery/ultrasonography ; Male ; Postoperative Complications ; *Radiography, Interventional ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; *Ultrasonography, Interventional

BACKGROUND/AIMS: Transcatheter arterial chemoembolization (TACE) is a major modality in the treatment of unresectable hepatocellular carcinoma. Acute renal failure (ARF) may occur after TACE because of underlying liver cirrhosis and the presence of radiocontrast agent. However, the data available regarding this complication are variable and limited. The aim of this study was to determine the incidence and associated risk factors of ARF after TACE. METHODS: From January 2001 to December 2004, a total of 632 procedures were performed in 377 patients. Of these, the cases with high creatinine levels (> or = 2 mg/dL) before TACE and with incomplete medical records were excluded, which resulted in 463 procedures in 319 patients (256 males and 63 females; age 58.7+/-9.9 years, mean+/-SD) being examined for this study. Various clinical and radiological data before and after the procedure were reviewed retrospectively. RESULTS: ARF occurred following 15 (3.2%) of the 463 procedures within 7 days of TACE. Univariate analysis revealed that serum albumin levels (P=0.025), Model for End-Stage Liver Disease score (P=0.001), the distribution of Child-Pugh class (P=0.027), and the proportions of patients with ascites (P<0.001), using diuretics (P=0.010), and with a serum creatinine level > or = 1.5 mg/dL (P=0.023) differed significantly between patients with or without ARF after TACE. In multivariate analysis, the presence of ascites (P=0.005; odds ratio, 5.297) and serum creatinine level > or = 1.5 mg/dL (P=0.007; odds ratio, 7.358) were independently associated with the development of ARF. CONCLUSIONS: The incidence of ARF after TACE was 3.2%, and the presence of ascites and an abnormal baseline serum creatinine level were the risk factors for ARF.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/complications/radiography/*therapy ; Chemoembolization, Therapeutic/*adverse effects/mortality ; Creatinine/blood ; Female ; Humans ; Incidence ; Kidney Failure, Acute/*epidemiology/etiology ; Liver Neoplasms/complications/radiography/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Analysis

No abstract available.
Antineoplastic Agents/administration & dosage ; Antiviral Agents/therapeutic use ; Atrophy/pathology ; Carcinoma, Hepatocellular/pathology/radiography/*therapy ; *Chemoembolization, Therapeutic ; Hepatectomy ; *Hepatic Veins ; Hepatitis B, Chronic/complications/diagnosis/drug therapy ; Humans ; Liver Neoplasms/pathology/radiography/*therapy ; Male ; Middle Aged ; *Portal Vein ; Tomography, X-Ray Computed

Hepatoblastoma usually occurs in children under the age of 2 years, with very few cases reported in adults. We experienced a case of adult hepatoblastoma in a 36-year-old female with chronic hepatitis B . She had experienced sudden onset abdominal pain. Her serum alpha-fetoprotein level was markedly elevated, and abdominal CT showed a 9-cm mass with internal hemorrhage in the right hepatic lobe with hemoperitoneum, so an emergency hepatic central bisectionectomy was performed. The initial histologic examination revealed that the mass mimicked combined hepatocellular carcinoma and cholangiocarcinoma with spindle-cell metaplasia of the cholangiocarcinoma element. Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area. Laparoscopic splenectomy with mass excision was performed, and hepatoblastoma was confirmed histologically. A histologic re-examination of previously obtained surgical specimens also confirmed the presence of hepatoblastoma. Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin . Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.
Adult ; Carcinoma, Hepatocellular/pathology ; Cholangiocarcinoma/pathology ; Cisplatin/therapeutic use ; Diagnostic Errors ; Doxorubicin/therapeutic use ; Drug Therapy, Combination ; Female ; Fluorouracil/therapeutic use ; Hepatitis B, Chronic/complications/diagnosis ; Hepatoblastoma/drug therapy/*pathology/radiography ; Humans ; Liver Neoplasms/drug therapy/*pathology/radiography ; Tomography, X-Ray Computed ; Vincristine/therapeutic use

OBJECTIVETo study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus.

METHODS22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Comparison of stent patency rate curves and survival curves was analyzed by Log rank test.

RESULTSThe portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying degrees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. I-II degree gastrointestinal tract reactions occurred in 3 cases, I-II degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25% , 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 12 months was 100%, 80% , 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05).

CONCLUSIONStent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.

Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; therapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; therapy ; Male ; Metals ; Middle Aged ; Neoplasm Invasiveness ; Portal Vein ; pathology ; Radiography ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Stents ; Survival Rate ; Treatment Outcome ; Venous Thrombosis ; diagnostic imaging ; etiology ; therapy