Bland Liver Tumor Embolization Complicated by Hepatic Abscess

Abstract

A 64-year-old man with metastatic pancreatic acinar cell carcinoma featuring BRCA2 mutation was referred to the authors' Interventional Oncology (IO) section to discuss treatment options for an enlarging left hepatic mass. In 2008, he underwent resection of locally advanced disease including Whipple procedure with total pancreatectomy, splenectomy, and partial left colectomy. He was placed on adjuvant therapy starting with FOLFOX until he developed dose-limiting toxicity. He then received gemcitabine as monotherapy followed by the addition of Abraxane until 2011. He developed liver metastases in 2012 and was placed on FOLFIRI prior to right hepatectomy with Roux-en-Y hepaticojejunostomy. In 2013, additional metastatic disease developed in his liver remnant and did not respond to carboplatin/taxol, or irinotecan/panitumumab. At the time of consultation, he was receiving irinotecan and panitumumab infusions and PO temozolomide.In clinic, he was appearing healthy and fully participating in work and activities of daily living (ECOG 0). His postpancreatectomy diabetes was well controlled. He denied hypertension, shortness of breath, chest pain, or other signs/symptoms. Review of imaging demonstrated a single large hypervascular left hepatic lobe mass measuring 12 cm  10 cm. There were postsurgical changes from the patient's prior right hepatectomy including pneumobilia. The portal vein was patent (►Fig.

Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies

“…Additional potential adverse events include the unlikely risk of embolization particles becoming exposed to the arterial supply of non-target tissue. Compromising the arterial supply of normal tissue can lead to gastrointestinal ulceration, hepatic abscess development, pancreatitis, and/or septicemia [39,40].…”