Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture: a case report

Abstract

BackgroundA ruptured hepatocellular carcinoma (HCC) is often fatal. In addition to surgery and transarterial embolization, radiofrequency ablation (RFA) might be another option for treating a ruptured HCC. Unfortunately, conventional RFA has a limited ablation zone; as such, it is rarely used to treat ruptured tumors.Case presentationThis case was a 60-year-old man who had a large, ruptured HCC in which hydrochloric acid (HCl)-enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.ConclusionConsidering the effectiveness of HCl-enhanced RFA in achieving hemostasis and tumor ablation, it might be a new option for treating large, ruptured HCCs.

Prognostic Significance of Immunohistochemical Markers and Genetic Alterations in Malignant Peripheral Nerve Sheath Tumors: A Systematic Review

“…Immunohistochemical expression of nine different receptors or their ligands were evaluated, most commonly the epidermal growth factor receptor (EGFR, Table 2 ) ( 4 , 29 , 37 – 39 , 55 , 56 , 63 , 64 ). Increased EGFR staining was associated with worse survival in univariable analysis in two/three studies, but this was not evaluated in a multivariable model ( 4 , 39 , 54 ).…”

“…Increased EGFR staining was associated with worse survival in univariable analysis in two/three studies, but this was not evaluated in a multivariable model ( 4 , 39 , 54 ). Increased phosphorylated MET (p-MET), C-X-C motif chemokine receptor 4 (CXCR4), and low fibroblast growth factor receptor 1 (FGFR1) staining were also associated with worse survival in univariable analysis, but only p-MET (HR 1.04, 95% CI: 1.0–1.1) and FGFR1 (HR 2.8, 95% CI: 1.2–6.7) were independently associated with survival ( 37 , 56 , 63 , 64 ). Increased EGFR and FGFR4 were associated with worse DFS, but only in univariable analyses ( 39 , 64 ).…”

“…Sixteen immunohistochemical markers of cell cycle regulation were evaluated, most commonly p53 ( Table 2 ) ( 4 , 24 , 26 , 28 , 29 , 33 , 40 , 42 , 43 , 46 , 47 , 51 , 53 , 56 , 60 , 61 , 63 ). Low p14, p16, checkpoint with forkhead-associated domain and ring finger (CHFR), and increase in p53, p14, cyclin D1, p27, and forkhead box protein M1 (FOXM1) staining were associated with worse survival in univariable analysis ( 4 , 26 , 28 , 40 , 42 , 43 , 51 , 56 , 61 ).…”

Hydrochloric acid enhanced radiofrequency ablation for treatment of large hepatocellular carcinoma in the caudate lobe: Report of three cases

“…Our previous experiments showed that infusing diluted HCl instead of normal saline during RFA could enlarge the diameter of ablation zone from a mean (SD) of 3.52 cm (0.07) to 6.85 cm (0.32) at 30 W-30 min[18]. This is because the conductivity of HCl is about three times higher than that of saline, greatly increasing the conductivity around the RF electrode[19]. In in vivo experiments, HRFA also exhibited a larger ablative zone with favorable safety[21-22].…”

“…In in vivo experiments, HRFA also exhibited a larger ablative zone with favorable safety[21-22]. Based on these studies, we have reported performing HRFA on a patient with spontaneously ruptured HCC, which successfully controlled bleeding and achieved complete necrosis after ablation without any complications[19]. In a word, HRFA, a technique that can create a large ablation volume by using a monopolar electrode, is promising in treating large caudate lobe HCCs.…”