Angiographic Demonstration of Intrahepatic Arterio-Portal Anastomoses in Hepatocellular Carcinoma

Okuda, Kunio; Musha, Hirotaka; Yamasaki, Takahiro; Jinnouchi, Shigenobu; Nagasaki, Yoshikazu; Kubo, Yasuhiko; Shimokawa, Yutaka; Nakayama, Toshimichi; Kojiro, Masamichi; Sakamoto, Kazuyoshi; Nakashima, Toshiro

doi:10.1148/122.1.53

Cited by 121 publications

(55 citation statements)

References 4 publications

(6 reference statements)

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“…Despite their application to the surgical resection of liver malignancies, however, recurrences are frequently found in the early postoperative period. It as yet remains unclear whether such lesions are due to pre-existing microscopic disease, result from surgical manipulation, or both.According to Okuda et al (1977), intrahepatic arterioportal anastomosis is demonstrated in 63.2% of patients with hepatocellular carcinoma, and retrograde flow of the portal vein trunk is seen in 25.4% as revealed by angiography. Therefore, tumour cell release into the portal vein during surgical treatment for liver malignancies may increase the metastasis of tumour to the liver.…”

mentioning

confidence: 99%

“…According to Okuda et al (1977), intrahepatic arterioportal anastomosis is demonstrated in 63.2% of patients with hepatocellular carcinoma, and retrograde flow of the portal vein trunk is seen in 25.4% as revealed by angiography. Therefore, tumour cell release into the portal vein during surgical treatment for liver malignancies may increase the metastasis of tumour to the liver.…”

mentioning

confidence: 99%

“…According to Okuda et al (1977) The drugs used in this study were OK-432 (Picibanil; Chugai Pharmaceutical Co. Ltd., Tokyo, Japan), 5-fluorouracil (5FU) and mitomycin C (MMC) (both from Kyowa Hakko Kogyo Co. Ltd., Tokyo, Japan).…”

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Promotion of hepatic metastases by liver resection in the rat

Mizutani

Hiraoka²,

Yamashita³

et al. 1992

Br J Cancer

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Summary In the early period following radical hepatectomy for hepatoma, recurrences in the remaining liver are frequently found. In regenerating liver, implantation and growth of tumour cells released into the portal system during surgical treatment might be promoted. We examined the relationship between liver regeneration and the formation of metastases following hepatic resection. Intraportal injections of rat ascites containing hepatoma AH130 cells at a concentration of 1 x IO' cells 0.2 ml-l were made at various periods following two thirds liver resection in rats. Tumour cell injections immediately at 24 h after surgery resulted in an increased number of hepatic metastases compared with control animals. Tumour cell injections 2 weeks after hepatectomy, however, had no significant difference in effect compared with control rats. In contrast, tumour cells injected immediately after removal of half of the caudate lobe resulted in the same number of metastases as control animals. These results demonstrate that the number of artificially induced hepatic metastases was increased during an initial period of active liver regeneration and was proportional to the volume of hepatectomy.The effect of 5-fluorouracil (5FU) or mitomycin C (MMC) as inhibitors of hepatic regeneration on liver metastasis after hepatectomy was studied. The administration of 5FU (20mg kg-') or MMC (0.2 mg kg-') immediately, 24 and 48 h after hepatectomy resulted in a marked reduction in metastatic lesions. The administration of 5FU caused delays in weight gain and decreases in the wet weight of remaining liver, while MMC had no effect on either. Accordingly, results of 5FU administration may be due to inhibitory effects on liver regeneration whilst that of MMC administration may be due to cytocidal antitumour effect. The effect of OK-432 as an immunoactivator on the implantation and growth of tumour cells in regenerating liver was also studied. Pretreatment with OK-432, 0.5 mg intraperitoneally on 7 consecutive days, had no effect on hepatic metastases.The pathophysiology of liver regeneration may enhance hematogenous hepatic metastasis and release of tumour cells during surgical manipulation may represent an important cause of recurrence following hepatic resection.Recent advances in preoperative diagnostic techniques and intraoperative ultrasonography have provided a greater ability to determine the number, location, and extent of liver lesions (Kanematsu et al., 1985; Makuuchi et al., 1987). Despite their application to the surgical resection of liver malignancies, however, recurrences are frequently found in the early postoperative period. It as yet remains unclear whether such lesions are due to pre-existing microscopic disease, result from surgical manipulation, or both.According to Okuda et al. (1977), intrahepatic arterioportal anastomosis is demonstrated in 63.2% of patients with hepatocellular carcinoma, and retrograde flow of the portal vein trunk is seen in 25.4% as revealed by angiography. Therefore, tumour cell release into the p...

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Promotion of hepatic metastases by liver resection in the rat

Mizutani

Hiraoka²,

Yamashita³

et al. 1992

Br J Cancer

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“…8,9 Conversely, several studies on the diagnosis of FNH have shown the importance of the drainage vessels. [10][11][12] Fukukura et al 10 studied the drainage vessels of FNH by injecting gelatin into the hepatic artery and portal vein of liver from autopsy and reported 2 pathways of vascular drainage in FNH. In the first pathway, blood entering the nodule from anomalous arteries drains directly into the hepatic veins.…”

Section: Discussionmentioning

confidence: 99%

“…An autopsy study reported that direct draining from the FNH into hepatic veins was seen in 31% of the FNH cases, whereas a direct hepatic vein drainage pattern was seen in only 1.8% of HCC cases. 11 Although drainage into hepatic veins has also been studied in detail with single-level dynamic CT during hepatic arteriography, the connection between the hepatic arteries and hepatic veins is not clear. In our present case, Levovistenhanced sonography was able to depict realtime drainage from the center of the tumor directly into the hepatic veins.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the Drainage Veins With Contrast‐Enhanced Sonography Was Useful in Diagnosis of Small Focal Nodular Hyperplasia

Iijima

Suzuki

Yanagisawa

et al. 2006

J of Ultrasound Medicine

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ocal nodular hyperplasia (FNH) is a benign localized lesion in the liver first reported by Edmondson 1 in 1956. Histologically, FNH is defined as a type of tumorlike lesion. Histopathologically, it is sometimes difficult to differentiate FNH from adenoma. Macroscopically, FNH is a nodule without a capsule showing a central stellate fibrous scar spreading from the center of the nodule radially toward the periphery. 2 These features have been regarded as the determining factors for imaging diagnosis. In dynamic computed tomography (CT) studies, the FNH is isoattenuating before contrast, showing homogenous hyperattenuation in the early arterial phase and isoenhancement during the portal venous phase. Diagnosis is facilitated by the presence of a central scar, but this feature can only be observed in approximately 50% of cases. 3 Although the vascular structure of FNH is said to be characterized by a typical spoke-wheel pattern and a stellate fibrous scar, 4 these features are not readily visualized in small FNH lesions. In such cases, it is necessary to differentiate from other hypervascular malignant tumors such as hepatocellular carcinoma (HCC) and metastatic lesions. 5 The recent advent of multi-detector row CT, 3-dimensional CT, and single-level dynamic CT during hepatic arteriography has allowed detailed visualization of the hemodynamics of FNH. According to these evaluations, the drainage veins of FNH are mainly the hepatic veins, although they sometimes drain directly into the sinusoids surrounding the tumor. 6 However, angiography is invasive, and 3-dimensional volume imaging does not allow real-time presentation. In this case, contrast-enhanced sonography using Levovist (SH U 508A; Schering AG, Berlin, Germany) enhanced the FNH in real time in the early arterial phase and clearly depicted subsequent drainage into the hepatic veins.

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Recovery of malignant tumor cells from the right atrium during hepatic resection for hepatocellular carcinoma

Koo

Fung

Siu

et al. 1983

Cancer

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Tumor cells were recovered from the right atrium in three of five patients during hepatic resection for hepatocellular carcinoma. Mechanical factors during blunt mobilization and rotation of the hepatic tumor appeared to be responsible for tumor dislodgement into the venous circulation. Tumor embolization to the lungs may be one of the important reasons for the poor results of surgery in this disease. Two possible technical and therapeutic modifications are suggested to prevent or neutralize this phenomenon.

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Angiographic Demonstration of Intrahepatic Arterio-Portal Anastomoses in Hepatocellular Carcinoma

Cited by 121 publications

References 4 publications

Promotion of hepatic metastases by liver resection in the rat

Promotion of hepatic metastases by liver resection in the rat

Visualization of the Drainage Veins With Contrast‐Enhanced Sonography Was Useful in Diagnosis of Small Focal Nodular Hyperplasia

Recovery of malignant tumor cells from the right atrium during hepatic resection for hepatocellular carcinoma

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