Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries

Masaki, Naohiko; Hayashi, Shigeki; Maruyama, Toshiyuki; Okabe, Hideo; Matsukawa, Masaya; Unno, Jun; Maekawa, Suguru; Oka, Teruaki; Tani, Masayoshi; Matsueda, Kei; Umeda, Noritsugu

doi:10.1007/bf00686660

Cited by 22 publications

(20 citation statements)

References 2 publications

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“…Physical findings include edema, pansystolic murmur, diastolic rumble over the tricuspid valve, and improved symptoms with left lateral decubitus position. 1,3,6 Successful surgical resections are reported, 7,8 but our patient's comorbities precluded such aggressive therapy.…”

Section: Discussionmentioning

confidence: 78%

Hepatocellular carcinoma extension into the right atrium

Hayashi

Trotter

Everson

2003

Liver Transplantation

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A 59-year-old man with cirrhosis of unclear etiology was referred to our hepatology clinic for transplantation evaluation. He drank regularly in his 20s, but had quit by age 30. He was hepatitis B core antibodypositive and hepatitis B surface antigen-negative. Serologic and biochemical workup was negative for other cirrhosis etiologies. The patient had no prior history of gastrointestinal bleeding, hepatic encephalopathy, or ascites. However, other medical problems included hepatopulmonary syndrome, coronary artery disease, obesity with severe deconditioning, and rheumatoid arthritis. Abdominal computed tomography scan ( Fig. 1) revealed a heterogeneous mass in the left lobe consistent with hepatocellular carcinoma (HCC). His ␣-fetoprotein level was 10.2 ng/mL. Bone scan and chest computed tomography scan were negative for metastatic disease. Transarterial chemoembolization was initiated while his transplantation evaluation proceeded. Transthoracic echocardiogram revealed a large undulating mass in the hepatic vein and extending 3.5 cm into the right atrium, consistent with tumor extension and thrombus (Fig. 2). Plans for further chemoembolization were canceled. More aggressive treatment such as intracardiac resection was deemed unfeasible because of his other medical problems. The patient entered hospice care.

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Section: Discussionmentioning

confidence: 78%

Hepatocellular carcinoma extension into the right atrium

Hayashi

Trotter

Everson

2003

Liver Transplantation

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“…En algunos pacientes, debido al avanzado estado de la enfermedad hepática, sólo se puede llevar a cabo tratamientos paliativos (embolización arterial, quimioterapia, radioterapia), con escaso beneficio clínico. Probablemente el desarrollo de tratamientos multidisciplinarios, junto con la resección quirúrgica del tumor, logre en un futuro una mayor supervivencia de estos pacientes (1,7).…”

Section: Discussionunclassified

“…El carcinoma hepatocelular tiene tendencia a invadir las venas hepáticas (y a través de ellas, puede extenderse al lado derecho del corazón) así como la vena porta, en sus estadíos avanzados (1). Esta invasión vascular puede, no obstante, ser una complicación temprana que no indica necesariamente inoperabilidad del tumor, lo que pone de manifiesto la importancia de su diagnóstico (2).…”

Section: Introductionunclassified

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

Fernández

Amado

Bello

et al. 2003

An. Med. Interna (Madrid)

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RESUMENEl hepatocarcinoma tiene tendencia a invadir estructuras vasculares. Es infrecuente, sin embargo, la afectación de las venas hepáticas y las metástasis intracardíacas. Presentamos el caso de un varón de 68 años con hepatopatía crónica por virus C, que consulta por edema y dolor a nivel del miembro inferior izquierdo. Mediante eco doppler, se objetivó, trombosis venosa profunda a dicho nivel y el TAC tóraco-abdominal, mostró, trombosis completa de la vena cava inferior, trombosis de la vena suprahepática izquierda, un voluminoso trombo en aurícula derecha y una masa irregular en hígado. La alfafetoproteína fue de 77.046 ng/ml. La biopsia del trombo de aurícula derecha estableció el diagnóstico de hepatocarcinoma. Se comenta la evolución del paciente tras la intervención quirúrgica, la frecuencia y clínica de esta complicación y las posibilidades terapéuticas en estos pacientes. HEPATOCELLULAR INVOLVING VASCULAR STRUCTURES AND HEART: DIAGNOSIS AND TREATMENT INTRODUCCIÓNEl carcinoma hepatocelular tiene tendencia a invadir las venas hepáticas (y a través de ellas, puede extenderse al lado derecho del corazón) así como la vena porta, en sus estadíos avanzados (1). Esta invasión vascular puede, no obstante, ser una complicación temprana que no indica necesariamente inoperabilidad del tumor, lo que pone de manifiesto la importancia de su diagnóstico (2). La incidencia de trombosis o afectación vascular es mucho más frecuente (13%) en casos de hepatocarcinoma que en tumores metastásicos (5%) o cirrosis (5%) (2).En general, existe una clara asociación entre tromboembolismo venoso y cáncer, sobre todo en pacientes mayores de 40 años. No obstante, sólo está justificado un screening invasivo de tumor primario ante la presencia de algún signo guía (3).Exponemos el caso de un paciente con carcinoma hepatocelular, trombosis venosa masiva y extensión a cavidades cardiacas derechas, comentando las técnicas diagnósticas utilizadas, tratamiento y evolución. CASO APORTADOVarón de 68 años de edad, sin antecedentes patológicos de interés, que consulta por edema y dolor a nivel de miembro inferior izquierdo. El paciente había sido estudiado ambulatoriamente por náuseas y dolor epigástrico detectándose en la analítica sanguínea aumento de transaminasas y serología positiva para hepatitis C. A la exploración física, el paciente presentaba buen estado general, ictericia conjuntival e ingurgitación venosa yugular. A nivel abdominal, existía circulación colateral sin semiología de ascitis y hepatomegalia de 2-3 cm. El miembro inferior izquierdo estaba edematoso y el

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“…This decreases the risk of systemic metastasis, sudden death due to pulmonary embolism, and tumor thrombus-related symptoms, such as edema and ascites [6,7]. Hence, although technically challenging, hepatic resection can be considered an acceptable treatment for HCC with tumor thrombus in patients with resectable primary tumors and sufficient hepatic reservoirs [8,9].…”

Section: Discussionmentioning

confidence: 99%

In-vivo hepatic procurement of tumor-free section followed by autotransplantation for large hepatocellular carcinoma with tumor thrombi extending into the inferior vena cava

Han¹

2017

Trends in Transplant

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In hepatocellular carcinoma (HCC) with thrombus formation in the major vasculature, to control unexpected life-threatening progression due to tumor extension into the inferior vena cava (IVC), ensure long-term survival, and improve quality of life (QOL), aggressive surgical approaches can be selectively adopted.We utilized outstanding living donor liver transplant (LDLT) techniques to develop an alternative surgical procedure with new concepts in large HCCs with tumor thrombi that have extended into the supra-hepatic IVC from the right hepatic vein (RHV) and middle hepatic vein (MHV).A 42-year-old man with a 10-cm HCC in the right lobe was transferred. We found tumor thrombi growing into the supra-hepatic IVC through the RHV, and a tumor thrombus that extended into the MHV through V8 was observed.Surgically, we first procured the left lobe, which had no involvement of the tumor or tumor thrombi, to avoid the spread of tumor thrombi. After securing an adequate operation field, a total hepatectomy was performed with simultaneous total hepatic vascular exclusion. The LDLT technique with modified extended left lobe graft after MHV reconstruction was used for auto-transplantation.Conclusively, this technique with new concepts for auto-transplantation offered our patient the potential to receive subsequent multidisciplinary treatments and an opportunity for improved QOL.

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Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries

Cited by 22 publications

References 2 publications

Hepatocellular carcinoma extension into the right atrium

Hepatocellular carcinoma extension into the right atrium

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

In-vivo hepatic procurement of tumor-free section followed by autotransplantation for large hepatocellular carcinoma with tumor thrombi extending into the inferior vena cava

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