HCC with tumor thrombus entering the right atrium and inferior vena cava treated by percutaneous ablation

Abstract

BackgroundIn the advanced stages of hepatocellular carcinoma (HCC), a tumor thrombus (TT) can form in the portal or hepatic vein. The management of patients with advanced HCC and a TT extending into the right atrium (RA) and inferior vena cava (IVC) is extremely difficult and risky.Case presentationWe report the case of a patient with HCC and a large TT (85 × 45 mm) extending into the RA through the hepatic vein and IVC, which is very rare. We performed percutaneous microwave ablation of the TT and the two intrahepatic tumors (maximum diameter, 57 mm). The treatment shrank the tumors, and the patient is in good condition and has survived for 16 months thus far. A literature review was also performed. This is the first such case to be treated with percutaneous microwave ablation.ConclusionThe outcomes in this case suggest that percutaneous ablation is useful for the treatment of TT extending into the RA and IVC in patients with HCC.

Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review

“…Two patients received interventional treatment: mechanical thrombectomy of the right atrial mass with subcutaneous enoxaparin and oral sorafenib in one patient who did not respond to sorafenib and died [41], and percutaneous microwave ablation in another patient in whom intrahepatic tumor recurrence occurred 3 months later and patient was alive as the tumor was completely ablated by TACE and salvage microwave ablation [22].…”

Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review

“…Interventional therapy was performed in 2 patients: mechanical thrombectomy of the mobile right atrial mass using the AngioVac cannula thrombectomy catheter with subcutaneous enoxaparin and oral sorafenib in one who did not respond to sorafenib and died [41] and percutaneous microwave ablation in another but intrahepatic tumor recurrence at 3 months while tumors were completely ablated by TACE and salvage microwave ablation who was alive [22].…”

Hepatocellular carcinoma with right atrial tumor thrombus: a meta-analysis

“…Chern MC, Chuang VP, Cheng T, Lin ZH, Lin YM. [3,20,22,26] 58 (53.7) Hepatitis B antigen positive [10, 13, 21, 23, 32-34, 46, 47, 50] 33 (30.6) Chronic hepatitis B [8,11,12,15,17,25,44] 17 (15.7) Hepatitis C 17 (9.1) Chronic hepatatis C [1,18,19,29,30,38,42,45,52] 10 (58.8) Hepatitis C virus antibody positive [5,27,31,50] 5 (29.4) Hepatitis C virus RNA very high [24] 1 (5.9) Hepatitis C virus-related end-stage liver disease [1] 1 (5.9) Chronic hepatitis, unspecified [39] 1 (0.5) Hepatitis, autoimmune [40] 1 (0.5) Cirrhosis [1,19,34,45,51] 7 (3.7) Hepatocellular carcinoma [1, 5, 15, 19, 20, 23, 30, 34, 36-38, 40, 45, 48, 51] 32 (17.1) Human immunodeficiency virus infection [44] 1 (0.5) Table II. 96 clinical symptoms in 36 patients Symptom n (%) Edema, lower extremity [5, 7-10, 14, 16, 34, 39, 42, 45, 46, 51] 13 (13.5) Ascites [1,5,8,19,21,<...>…”

“…Abdominal pain [1,8,14,21,24,32,33,38,39] 9 (9.4) Dyspnea [1,5,16,19,28,32,39,51] 9 (9.4) Shortness of breath [6,8,15,24,41,44] 6 (6.3) Poor appetite [6,9,14,19,32] 5 (5.2) Weight loss [8,12,13,32] 4 (4.2) Asymptomatic [2,20,22,25] 4 (4.2) Altered mental status [6,16] 2 (2.1) Asthenia/weakness [13,19] 2 (2.1) Chest distress [19,46] 2 (2.1) Chest pain [41,44] 2 (2.1) Epigastralgia [6,7] 2 (2.1) Others 17 (17.7) Tumor thrombus-invaded vasculature n (%) Inferior vena cava [1, 2, 4, 5, 6, 8-11, 13-41, 44-52] 80 (42.8) Portal vein [6-8, 12, 17, ...…”