Hepatocellular Carcinoma: Involvement of the Internal Mammary Artery

Nakaï, Motoki; Sato, Morio; Kawai, Nobuyuki; Minamiguchi, Hiroki; Masuda, Mitsunori; Tanihata, Hirohiko; Takeuchi, T; Tomita, Masaki; Kishi, Kazushi

doi:10.1148/radiology.219.1.r01mr28147

Cited by 53 publications

(30 citation statements)

References 16 publications

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“…In the present study, extrahepatic collateral blood supplies to P-HCC commonly arose from gastroduodenal arteries, left gastric arteries, phrenic arteries, superior mesenteric arteries, pancreaticoduodenal arteries and right adrenal arteries. In patients with P-HCC, various extrahepatic collateral vessels develop and supply the tumor (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Compared with those observed via angiographies at the initial TACE, up to 79.5% of the patients in the present study had extrahepatic collateral supplies following subsequent TACE; the results also revealed an increasing trend in the number of extrahepatic collateral vessels as the number of TACE treatments increased.…”

Section: Discussionsupporting

confidence: 52%

“…Compared with those observed via angiographies at the initial TACE, up to 79.5% of the patients in the present study had extrahepatic collateral supplies following subsequent TACE; the results also revealed an increasing trend in the number of extrahepatic collateral vessels as the number of TACE treatments increased. Therefore, it was hypothesized that the main cause of the development of extrahepatic collaterals was attenuation of the hepatic arterial circulation by TACE (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Technically, angiographies of blood supplies to the liver, including the celiac, common hepatic and superior mesenteric arteries, should be initially performed during TACE in all patients with P-HCC, as the intrahepatic arteries manifest as the main blood supply to P-HCC (14).…”

Section: Discussionmentioning

confidence: 99%

“…Technically, angiographies of blood supplies to the liver, including the celiac, common hepatic and superior mesenteric arteries, should be initially performed during TACE in all patients with P-HCC, as the intrahepatic arteries manifest as the main blood supply to P-HCC (14). An arteriogram of the inferior phrenic artery, which is a major source of diaphragmatic blood supply to the liver (12,19,(22)(23)(24)(25)(26)29), is routinely performed in patients who have an interrupted hepatic arterial circulation owing to previous treatment, or in patients with tumors located near the diaphragm, which may be identified in the initial angiography.…”

Section: Discussionmentioning

confidence: 99%

“…Extrahepatic collateral blood supplies may prohibit effective treatment by TACE. For the transcatheter management of P-HCC to be effective, these collateral blood supplies must be adequately embolized (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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...

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Sometimes, the development of extrahepatic collaterals supplying liver tumors prohibits effective control of the tumor by hepatic artery chemoembolization. Therefore, it is essential to check for extrahepatic collateral arterial supply to the HCC, especially when tumor is in subcapsular location or shows exophytic tumor growth [328]. When the hepatic artery and extrahepatic collaterals supply the tumor, additional chemoembolization of the extrahepatic collaterals can be tried to increase the therapeutic efficacy of TACE [329,330].…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse

et al. 2001

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Hepatocellular Carcinoma: Involvement of the Internal Mammary Artery

Abstract: These results strongly suggest that, regardless of tumor size, when HCCs are located in the ventral hepatic areas directly beneath the diaphragm, the IMAs serve as feeding arteries in patients with hepatic artery occlusion caused by repeated TAE.

Cited by 53 publications

References 16 publications

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

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

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Transarterielle Chemoembolisation bei hepatozellulären Karzinomen: Technik, Indikationsstellung, Ergebnisse

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