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Nomura Y, Sakai H, Akiba J, Hisaka T, Sato T, Goto Y, Akashi M, Fukutomi S, Muroya D, Kanno H, Okamura S, Yano Y, Yano H, Akagi Y, Okuda K. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report. BMC Surg 2021; 21:122. [PMID: 33685435 PMCID: PMC7941886 DOI: 10.1186/s12893-021-01115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation
An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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Affiliation(s)
- Yoriko Nomura
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University Hospital, Kurume, Japan.
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Toshihiro Sato
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Yuichi Goto
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Masanori Akashi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Shogo Fukutomi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Daisuke Muroya
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Hiroki Kanno
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Shusuke Okamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yuta Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University Hospital, Kurume, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University Hospital, Kurume, Japan
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Popovic P, Stabuc B, Jansa R, Garbajs M. Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control. Radiol Oncol 2016; 50:418-426. [PMID: 27904450 PMCID: PMC5120574 DOI: 10.1515/raon-2015-0045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/19/2015] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this retrospective study was to evaluate treatment response, adverse events and survival rates of patients with intermediate stage HCC treated with superselective doxorubicin-loaded DC Bead transarterial chemoembolization (DEBDOX) under cone beam computed tomography (CBCT) control. Patients and methods Between October 2010 and June 2012, 35 consecutive patients with intermediate stage HCC (32 male, 3 female; average age, 67.5 ± 7.8 years; 22 patients Child-Pugh class A, 8 class B, 5 without cirrhosis) were treated with DEBDOX TACE. Portal vein thrombosis was observed in 6 (17.1%) patients. DEBDOX TACE was performed by superselective catheterization of feeding vessels followed by embolization with 100-300 μm microspheres loaded with 50-100 mg of doxorubicin. In all cases, CBCT was used during chemoembolization. Tumor response rates were defined according to mRECIST criteria. Results Overall, 120 procedures were performed (mean, 3.2 per patients). We treated 97 lesions with an average diameter of 4.9 ± 1.9 cm. There were 32 minor and 2 (1.6%) major complications (one liver abscess and one cerebrovascular insult). After a mean follow-up of 27.7 ± 10.5 months, 94.3% of patients achieved an objective response to treatment (42.4% complete response and 57.6% partial response). Mean time to progression was 10.9 ± 5.3 months. Mean overall survival was 33.9 months (95% CI; 28.9 – 38.9 months), with 1- and 2- year survival of 97.1% and 65.7%, respectively. Conclusions Superselective DEBDOX TACE performed under CBCT control is a safe and effective method with high rates of tumor response and overall survival.
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Affiliation(s)
- Peter Popovic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Stabuc
- Gastroenterology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rado Jansa
- Gastroenterology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Manca Garbajs
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Hur S, Chung JW, Zhou CG, Lee JH, Cho S, Kim M, Lee M, Kim HC, Jae HJ. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery. Eur Radiol 2016; 27:1440-1447. [PMID: 27510629 DOI: 10.1007/s00330-016-4523-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). MATERIALS AND METHODS From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. RESULTS The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. CONCLUSION Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. KEY POINTS • Prevalence of hepatic falciform artery is 95 %, higher than previously known. • 22 % of conspicious hepatic falciform arteries distributed in subcutaneous tissue around umbilicus. • The existence of Sappey's superior artery was proved with a radiological method.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744.
| | - Chun Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jangsu, China
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - SooBeum Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Minuk Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
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Vesselle G, Petit I, Boucebci S, Rocher T, Velasco S, Tasu JP. Radioembolization with yttrium-90 microspheres work up: Practical approach and literature review. Diagn Interv Imaging 2014; 96:547-62. [PMID: 24776810 DOI: 10.1016/j.diii.2014.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radioembolization (RE) is a selective internal radiotherapy technique in which yttrium-90 blended microspheres are infused through the hepatic arteries. It is based on the fact that primary and secondary hepatic tumors are vascularized mostly by arterial blood flow whereas healthy hepatocytes obtain their blood supply mostly from the portal network. This enables high radiation doses to be delivered, sparing the surrounding non-malignant liver parenchyma. Most of the complications are caused by unexpected particles passing into the gastrointestinal tract through branches originating from the main hepatic arterial supply. Knowledge of this hepatic arterial network and of its variations and the technical considerations this raises are required in preparation for treatment. This work describes the specific anatomical features and techniques for this anatomy through recent literature illustrated by cases from our own experience.
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Affiliation(s)
- G Vesselle
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France.
| | - I Petit
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - S Boucebci
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - T Rocher
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - S Velasco
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
| | - J-P Tasu
- Functional and Therapeutic Diagnostic Imaging Unit, Poitiers University Hospital, rue de la Milétrie, 86000 Poitiers, France
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Safety of chemotherapeutic infusion or chemoembolization for hepatocellular carcinoma supplied exclusively by the cystic artery. Cardiovasc Intervent Radiol 2012; 36:1313-9. [PMID: 23262478 DOI: 10.1007/s00270-012-0542-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/22/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was designed to evaluate the safety of chemotherapeutic infusion or chemoembolization by way of the cystic artery in patients with hepatocellular carcinoma (HCC) supplied exclusively by the cystic artery. METHODS Between Jan 2002 and Dec 2011, we performed chemotherapeutic infusion or chemoembolization using iodized oil for the treatment of 27 patients with HCC supplied exclusively by the cystic artery. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. RESULTS The cystic artery originated from the main right hepatic artery in 24 (89 %) patients, from the right anterior hepatic artery in 2 (7 %) patients, and from the left hepatic artery in 1 (4 %) patient. Selective catheterization of the cystic artery was achieved in all patients. Superselection of tumor-feeding vessels from the cystic artery was achieved in 7 patients (26 %). Chemotherapeutic infusion was performed in 18 patients (67 %), and chemoembolization was performed in 9 patients (33 %). There were no major complications and only 2 minor complications, including vasovagal syncope and nausea with vomiting. Individual tumor response supplied exclusively by the cystic artery at the follow-up enhanced CT scan were complete response (n = 16), partial response (n = 3), and stable disease (n = 8). CONCLUSION HCC supplied exclusively by the cystic artery can be safely treated without severe complications by chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.
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