Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Abstract

Abstract. Pedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, defined as a carcinoma protruding from the liver with or without a pedicle with a low degree of liver invasion. The present study aimed to evaluate the characteristics of blood supply of P-HCC prior to and following transcatheter arterial chemoembolization (TACE) treatment. Angiographic findings prior to and following TACE treatment in 39 patients with P-HCC were analyzed retrospectively. Angiography performed at the first TACE session revealed 70 tumor-feeding arteries collectively in all patients, including 31/70 (44.0%) extrahepatic parasitic arteries in 23/39 patients (59.0%). The intrahepatic arteries served as the main blood supply to P-HCC in all patients. Extrahepatic collateral blood supplies to P-HCCs were significantly associated with larger tumor diameter (χ 2 =164.000, P<0.001), but not tumor location (χ 2 =7.358, P=0.061). Following repeated TACE treatment, all angiographies revealed a total of 131 tumor feeding arteries collectively in all patients, including intrahepatic arteries (54/131) and extrahepatic collateral arteries (78/131) in 31 patients (79.5%). Compared with angiographies performed at the initial TACE treatment, these results also demonstrated an increase in the number of extrahepatic collateral arteries, which produced 47 new blood vessels (χ 2 = 4.278, P= 0.039). P-HCC tumor lesions readily acquired a parasitic blood supply from adjacent vessels following repeated TACE. Intrahepatic arteries functioned as the main blood supply for P-HCC, whereas extrahepatic collateral arteries were complementary to P-HCC, regardless of whether the patient was pre-or post-TACE. Extrahepatic collateral supplies to P-HCCs that originated from adjacent vessels were rich, were closely associated with tumor size, and were prone to be newly established following repeated TACE. IntroductionPedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, which is defined as a carcinoma protruding from the liver with or without a pedicle, and with a low degree of liver invasion (1). P-HCC was first described by Roux in 1897 (2), and represents 0.24-3.00% of all cases of HCC in Japan (3,4). Additionally, to the best of our knowledge, <200 cases have been reported in previous studies (4-6).The majority of P-HCC cases are treated surgically, with higher operability rates and better survival than conventional HCC, which may be due to its unique growth pattern, high rate of tumor capsule formation and lower vascular invasion (4-6). However, up to 39.4% of patients with P-HCC are unable to undergo surgical resection (7). Therefore, palliative treatments may serve a central function in the treatment of unresectable P-HCC. Transcatheter arterial chemoembolization (TACE) is the most widely used locoregional therapy for patients with intermediate HCC, who cannot be treated surgically (8-11). However, the blood supply to P-HCC is complicated, arising from hepatic arteries and extrahepatic collateral vessels (3). P-HCC tumor lesions prot...

Safety and effectiveness of multi-antenna microwave ablation-oriented combined therapy for large hepatocellular carcinoma

“…7 However, because tumor neovascularization can rapidly restore tumor blood supply after TACE, TACE alone is not generally considered a potentially curative treatment for HCC. 8…”

“…7 However, because tumor neovascularization can rapidly restore tumor blood supply after TACE, TACE alone is not generally considered a potentially curative treatment for HCC. 8 An alternative minimally invasive approach to treating HCC involves the use of thermal ablation, and this has been shown to be potentially curative for small (⩽3 cm) HCC. 9 However, conventional energy ablation techniques for treating HCC have typically used only a single antenna to deliver energy, resulting in relatively small ablation zones and increased risks of local tumor residual, intrahepatic recurrences, or distant metastases, particularly in intermediate-sized (⩽5 cm) HCC.…”

Quantitative analysis with multiphase contrast-enhanced computed tomography to evaluate residual tumor activity of hepatocellular carcinoma after DEB-TACE

“…However, in Huang Juan’s study of 50 cases of HCC, 36 (72%) were supplied by hepatic arterial blood, 6 (12%) by arterial combination with portal blood supplying, 4 (8%) by portal blood supply, and 4 (8%) with poor blood supplying. [ 26 ] Another earlier study also found that although most HCC lesions can be detected in the arterial phase, some can only be detected in the portal or delayed phase. [ 21 ] According to another study, [ 27 ] up to 79.5% of patients will have a new extrahepatic collateral supply after TACE.…”