Pathologic and Radiographic Studies of Intrahepatic Metastasis Hepatocellular Carcinoma; The Role of Efferent Vessels

Abstract

The efferent vessel of hepatocellular carcinoma (HCC) and the mechanism and pathogenesis of the high frequency of intrahepatic metastasis in HCC has not yet been clarified. Three hundred ninety-three resected specimens of HCC were examined for tumor thrombosis in the portal vein and the hepatic vein: 231 tumors <-5 cm in diameter were examined for the relationship between mode of tumor spread and tumor size. Efferent vessels in HCC were identified by direct injection of radiopaque material into the tumor in 23 resected liver specimens and by percutaneous infusion of radiopaque media into tumor nodules in 8 patients. The mode of tumor spread in HCC progressed from capsular invasion to extracapsular invasion, then to vascular invasion, and finally to intrahepatic metastasis. There was a strong statistical correlation between the presence of intrahepatic metastasis and portal vein thrombosis (p<0.05, R=0.998). Radiopaque material injected directly into 23 resected tumors entered only the portal vein in 17 tumors and into both the portal and hepatic veins in 6 tumors. In all 8 patients with unresectable lesions, radiopaque media injected percutaneously into tumor nodules flowed only into the portal vein. These findings suggest that intrahepatic invasion by HCC may occur through the portal vein as an efferent tumor vessel.

Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: Univariate and multivariate analysis

“…Numerous previous studies have demonstrated that the presence of either microscopic or macroscopic vascular invasion is the key risk factor for recurrence [18,19]. Intrahepatic metastasis via the portal venous system is generally accepted as an important mechanism for intrahepatic recurrence [20,21]. This study confirmed that vascular invasion in HCC patients with cirrhosis who underwent hepatectomy increased the chances of reducing long-term survival by 2.347 times.…”

Risk Factors for Early and Late Intrahepatic Recurrence in Patients with Single Hepatocellular Carcinoma Without Macrovascular Invasion after Curative Resection

“…The presence of vascular invasion is considered to be the direct evidence of intrahepatic metastasis. Toyosaka et al proved that the HCC spread progressed from capsular invasion to extracapsular invasion, then to vascular invasion, and finally to intrahepatic metastasis (Toyosaka et al, 1996). This findings strongly suggests that IM is mainly attributable to early recurrence for HCC patients after curative resection.…”

Risk Factors for Early Recurrence of HBV-related Hepatocellular Carcinoma Meeting Milan Criteria after Curative Resection

“…Intrahepatic metastases via the portal venous system are widely accepted as a main mechanism for intrahepatic recurrence (Toyosaka et al, 1996). Hasegawa et al (2005) demonstrated that anatomic resection can help to reduce the possibility of early recurrence resulting from vascular invasion and had a better outcome than nonanatomic resection.…”