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Frazzitta AE, Kay MD, Warhadpande D, Kuo PH. Diagnosis of Pulmonary Embolism on 99mTc-Labeled Macroaggregated Albumin Lung Imaging After Hepatic Arterial Injection for Planning of Radioembolization. Clin Nucl Med 2022; 47:e246-e248. [PMID: 35025793 DOI: 10.1097/rlu.0000000000004026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 54-year-old man with hepatocellular carcinoma from alcohol-induced cirrhosis presented with hepatic encephalopathy and refractory ascites related to decompensated liver disease. MRI confirmed disease progression adjacent the site of prior radiofrequency ablation, performed 2 years prior, with associated right hepatic vein tumor thrombus. 99mTc-labeled macroaggregated albumin lung shunt imaging performed before 90Y radioembolization identified a left lower lobe wedge-shaped defect, confirmed as pulmonary embolism on CT pulmonary angiography and MRI.
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Affiliation(s)
- Aubrey E Frazzitta
- From the Department of Medical Imaging, University of Arizona College of Medicine
| | - Matthew D Kay
- From the Department of Medical Imaging, University of Arizona College of Medicine
| | - Devdutta Warhadpande
- From the Department of Medical Imaging, University of Arizona College of Medicine
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2
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Deng D, Wu H, Wei H, Song Z, Yu Y, Zhang C, Yang L. Syncope as the initial presentation of pulmonary embolism in two patients with hepatocellular carcinoma: Two case reports and literature review. Medicine (Baltimore) 2021; 100:e27211. [PMID: 34559110 PMCID: PMC8462621 DOI: 10.1097/md.0000000000027211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors. PATIENT CONCERNS Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission. DIAGNOSES Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed. INTERVENTIONS Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed. OUTCOMES The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed. LESSONS It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.
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Affiliation(s)
- Dayong Deng
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Haidi Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Huafang Wei
- Department of Internal Medicine-1, Jilin Provincial Cancer Hospital, Changchun, China
| | - Zikai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Yang Yu
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Chongyin Zhang
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Lei Yang
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
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3
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Liu J, Zhang RX, Dong B, Guo K, Gao ZM, Wang LM. Hepatocellular carcinoma with inferior vena cava and right atrium thrombus: A case report. World J Clin Cases 2021; 9:7893-7900. [PMID: 34621843 PMCID: PMC8462251 DOI: 10.12998/wjcc.v9.i26.7893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with inferior vena cava and right atrium thrombus is rare, accounting for approximately 1.4%-4.9% of cases. These patients are rarely reported, but the condition is being increasingly discovered with advances in imaging techniques, and their prognosis is extremely pessimistic with no current effective treatment. This condition is further associated with unexpected sudden death by cardiac arrest and acute large area pulmonary embolism.
CASE SUMMARY A 34-year-old man with advanced HCC with a hepatic vein thrombus extending into the right atrium had a long-term, disease-free survival following 5-mo sequential treatment combined with transcatheter arterial chemoembolization and curative liver resection. No severe adverse effects were encountered, such as massive hemorrhage or pulmonary embolism. The proper selection of operative method is an important factor.
CONCLUSION HCC with a tumor thrombus extending into the right atrium has a significant impact on the survival of patients. Thrombectomy combined with adjuvant therapy may be beneficial for these patients.
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Affiliation(s)
- Jin Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Ri-Xin Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Bing Dong
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Kun Guo
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Zhen-Ming Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Li-Ming Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
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4
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He X, Anthony DC, Catoni Z, Cao W. Pulmonary tumor embolism: A retrospective study over a 30-year period. PLoS One 2021; 16:e0255917. [PMID: 34379693 PMCID: PMC8357121 DOI: 10.1371/journal.pone.0255917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.
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Affiliation(s)
- Xin He
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Pathology, University of Massachusetts School of Medicine, Worcester, MA, United States of America
| | - Douglas C. Anthony
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Neurology, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Zulmira Catoni
- Human Information Management, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Weibiao Cao
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- * E-mail:
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5
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Lee HA, Park S, Seo YS, Yoon WS, Shin I, Rim CH. Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta‐analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:1031-1046. [DOI: 10.1002/jhbp.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Han Ah Lee
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Sunmin Park
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - Yeon Seok Seo
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Won Sup Yoon
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - In‐Soo Shin
- Graduation School of Education Dongguk University Seoul Korea
| | - Chai Hong Rim
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
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Tomita K, Shimazu M, Takano K, Gunji T, Ozawa Y, Sano T, Chiba N, Abe Y, Kawachi S. Resection of recurrent hepatocellular carcinoma with thrombi in the inferior vena cava, right atrium, and phrenic vein: a report of three cases. World J Surg Oncol 2020; 18:138. [PMID: 32571339 PMCID: PMC7310451 DOI: 10.1186/s12957-020-01914-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Prognosis for patients with advanced hepatocellular carcinoma with a tumor thrombus in the inferior vena cava or right atrium is extremely poor due to cancer progression, pulmonary embolism, and congestion of the circulatory system caused by right heart failure. Surgical resection of the tumor thrombi may potentially yield better results than non-surgical treatments through prevention of sudden death. However, the benefits of surgical resection in patients with hepatocellular carcinoma and a tumor thrombus extending to the inferior vena cava, right atrium, and potentially in the phrenic vein are unclear. Here, we report three such cases. Case presentation Of the total 136 patients who underwent hepatectomies for hepatocellular carcinoma in our institution, three patients with prior hepatectomies and recurrent hepatocellular carcinoma had tumor thrombi in the inferior vena cava, right atrium, and phrenic vein. Surgical resections were performed, as there was a possibility of sudden death, despite the risk of leaving residual tumor. For all patients, we performed resection of the tumor thrombi in the inferior vena cava and right atrium and combined diaphragm resection. Surgical resection was performed using the total hepatic vascular exclusion technique in all cases. Additional passive veno-venous bypass was also performed in two cases, in which complete tumor resections could not be achieved. The microscopic surgical margins of the combined resected diaphragms were positive in all cases. Progression-free survival was 20.2, 3.8, and 9.5 months for case 1, 2, and 3, respectively. The respective overall postoperative survival was 98.0, 38.9, and 30.9 months. The patients died due to liver cirrhosis, acute heart failure, and hepatocellular carcinoma, respectively. Sudden death did not occur for any of the patients. Conclusion Surgical resections may extend prognosis for patients with recurrent hepatocellular carcinoma with tumor thrombi in the inferior vena cava, right atrium, and phrenic vein, although the indications should be considered carefully.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamada, Machida-shi, Tokyo, 194-0297, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa, 254-0065, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
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7
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Morita S, Kamimura K, Abe H, Watanabe-Mori Y, Oda C, Kobayashi T, Arao Y, Tani Y, Ohashi R, Ajioka Y, Terai S. Pulmonary tumor thrombotic microangiopathy of hepatocellular carcinoma: A case report and review of literature. World J Gastroenterol 2019; 25:6949-6958. [PMID: 31908398 PMCID: PMC6938728 DOI: 10.3748/wjg.v25.i48.6949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition in patients with hepatocellular carcinoma (HCC); to date, few cases have been reported. While hepatic dysfunction has been focused on the later stages of HCC, the management of symptoms in PTTM is important for supportive care of the cases. For the better understanding of PTTM in HCC, the information of our recent case and reported cases have been summarized.
CASE SUMMARY A patient with HCC exhibited acute and severe respiratory failure. Radiography and computed tomography of the chest revealed the multiple metastatic tumors and a frosted glass–like shadow with no evidence of infectious pneumonia. We diagnosed his condition as acute respiratory distress syndrome caused by the lung metastases and involvement of the pulmonary vessels by tumor thrombus. Administration of prednisolone to alleviate the diffuse alveolar damages including edematous changes of alveolar wall caused by the tumor cell infiltration and ischemia showed mild improvement in his symptoms and imaging findings. An autopsy showed the typical pattern of PTTM in the lung with multiple metastases.
CONCLUSION PTTM is caused by tumor thrombi in the arteries and thickening of the pulmonary arterial endothelium leading to the symptoms of dyspnea in terminal staged patients. Therefore, supportive management of symptoms is necessary in the cases with PTTM and hence we believe that the information presented here is of great significance for the diagnosis and management of symptoms of PTTM with HCC.
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Affiliation(s)
- Shinichi Morita
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yukari Watanabe-Mori
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Chiyumi Oda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takamasa Kobayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yoshihisa Arao
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yusuke Tani
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Riuko Ohashi
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Histopathology Core Facility, Niigata University Faculty of Medicine, Niigata University, Niigata 951-8510, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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8
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Gatti P, Giorgio A, Ciracì E, Roberto I, Anglani A, Sergio S, Rizzello F, Giorgio V, Semeraro S. Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report. J Ultrasound 2019; 22:363-370. [PMID: 30864004 DOI: 10.1007/s40477-019-00361-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is the most common form of liver cancer. In advanced cancer stages (metastatic disease and/or vascular invasion), the generally accepted standard of care is systemic therapy using sorafenib as first-line treatment and, recently, regorafenib and nivolumab as second-line treatment, but the quality of life and the prognosis of patients remain very poor. Our paper reports a case of US-guided radiofrequency ablation (RFA) of both intraparenchymal HCC and inferior vena cava tumor thrombus. METHODS We treated a patient with HCC associated with tumor thrombus extending into vena cava after failure of sorafenib therapy using US-guided radiofrequency ablation (RFA). RESULTS A good radiological and clinical response was observed in association with excellent tolerability. The patient has been followed up for 15 months from the ablation, is alive, and is in a good clinical condition without evidence of tumor recurrence. CONCLUSION This is the first case in which this minimally invasive percutaneous procedure has been successfully used to treat an HCC thrombus entering the vena cava.
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Affiliation(s)
- Pietro Gatti
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Emanuela Ciracì
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Italia Roberto
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | | | - Spano Sergio
- Interventional Radiology Unit, Perrino Hospital, Brindisi, Italy
| | - Fernando Rizzello
- Anesthesiology and Reanimation Unit, Ostuni Hospital, Ostuni, BR, Italy
| | - Valentina Giorgio
- Pediatric Gastroenterology Unit, Policlinico Gemelli, Sacred Heart University, Rome, Italy
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9
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Sakamoto K, Nagano H. Outcomes of surgery for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium. Surg Today 2017; 48:819-824. [PMID: 29279997 DOI: 10.1007/s00595-017-1619-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
Abstract
The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is extremely poor. We reviewed the recent surgical treatments and outcomes of this form of advanced HCC. TT is classified into three types according to its anatomic location relative to the heart: the inferior hepatic type (type I), where the TT is in the IVC below the diaphragm; the superior hepatic type (type II), where the TT is in the IVC above the diaphragm, but still outside the RA; and the intracardiac type (type III), where the TT is above the diaphragm and has entered the RA. Type I can be treated relatively easily by standard radical hepatectomy. For type II, the intrathoracic IVC is approached via the abdominal cavity and an incision in the diaphragm with total hepatic vascular exclusion (THVE). For type III, hepatectomy plus thrombectomy is generally performed under cardiopulmonary bypass. If the TT is only just inside the RA, THVE can be performed by mobilizing the liver caudally. The median overall survival of HCC patients with TT in the IVC or RA, who undergo curative resection, is 19.0-30.8 months. As postoperative recurrence is likely to develop, even after curative surgery, effective postoperative adjuvant chemotherapy is required.
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Affiliation(s)
- Kazuhiko Sakamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
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10
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Barrett M, Viglianti BL, Hanson CA, Schildhouse RJ. A Case of Right Atrial Obliteration Caused by Intracardiac Extension of Hepatocellular Carcinoma. Case Rep Oncol 2017; 10:8-14. [PMID: 28413389 PMCID: PMC5385863 DOI: 10.1159/000455092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 12/13/2022] Open
Abstract
As the fifth most common malignancy worldwide, hepatocellular carcinoma (HCC) is a frequently encountered clinical entity. Symptomatology associated with the diagnosis includes hepatic dysfunction and pain from capsular spread. Additionally, due to its propensity for vascular spread, extrahepatic intravascular involvement can also be seen. We present a unique case of intracardiac involvement of HCC. Originally diagnosed as acute on chronic heart failure, echocardiography revealed the symptom source – tumor obliteration of the right atrium. Clinical case presentation and management, along with radiographic images are presented. A review of the current literature highlights this uncommon presentation and the need for clinical suspicion of cardiac involvement in patients with a history of HCC presenting with heart failure.
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Affiliation(s)
- Meredith Barrett
- Section of General Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Benjamin L Viglianti
- Department of General Medicine, Division of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Division of General Medicine, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
| | - Christopher A Hanson
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Nuclear Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Radiology, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
| | - Richard J Schildhouse
- Department of General Medicine, Division of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Division of General Medicine, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
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11
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Li W, Wang Y, Gao W, Zheng J. HCC with tumor thrombus entering the right atrium and inferior vena cava treated by percutaneous ablation. BMC Surg 2017; 17:21. [PMID: 28245832 PMCID: PMC5331644 DOI: 10.1186/s12893-017-0217-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/22/2017] [Indexed: 12/16/2022] Open
Abstract
Background In 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 presentation We 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. Conclusion The 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.
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Affiliation(s)
- Wei Li
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, 8 Xitoutiao, Youanmenwai St., Fengtai Dist., Beijing, 100069, People's Republic of China
| | - Yang Wang
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, 8 Xitoutiao, Youanmenwai St., Fengtai Dist., Beijing, 100069, People's Republic of China
| | - Wenfeng Gao
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, 8 Xitoutiao, Youanmenwai St., Fengtai Dist., Beijing, 100069, People's Republic of China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, 8 Xitoutiao, Youanmenwai St., Fengtai Dist., Beijing, 100069, People's Republic of China.
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12
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Luo X, Zhang B, Dong S, Zhang B, Chen X. Hepatocellular Carcinoma With Tumor Thrombus Occupying the Right Atrium and Portal Vein: A Case Report and Literature Review. Medicine (Baltimore) 2015; 94:e1049. [PMID: 26313767 PMCID: PMC4602908 DOI: 10.1097/md.0000000000001049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 05/12/2015] [Accepted: 05/30/2015] [Indexed: 02/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) patients with tumor thrombus extended through the major hepatic veins and inferior vena cava into the right atrium (RA) are rare, and most cases are considered as the advanced stage with a poor prognosis.We report a case of HCC with a tumor thrombus extending into the RA and a tumor thrombus in the portal vein. A literature search for case reports was performed on PubMed.Compared with the published literature, our case is one of the youngest patients, but with the most advanced HCC that invades both the hepatic inflow and outflow vasculature. For this patient, we resected the tumor thrombus in the RA with the use of cardiopulmonary bypass, and then removed the tumor thrombus in the portal vein and ligated the left branch of portal vein. Because of insufficient remnant liver volume, microwave ablation and transcatheter arterial chemoembolization were performed to control the growth of HCC. The patient survived 6 months after surgery.This case suggests that for patients with extension of HCC into the RA and portal vein, surgery is a useful therapeutic modality, even in case that liver tumor cannot be resected.
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Affiliation(s)
- Xin Luo
- From the Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bahsi R, Dogan Z, Taser N, Aktas MN, Filik L. Acute cor pulmonale: an unusual presentation of hepatocellular carcinoma. Acta Clin Belg 2015; 70:76. [PMID: 25186945 DOI: 10.1179/2295333714y.0000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- R. Bahsi
- Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - Z. Dogan
- Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - N. Taser
- Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - M. N. Aktas
- Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - L. Filik
- Internal Medicine, Ankara Education and Research Hospital, Ankara, Turkey
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Jun CH, Sim DW, Kim SH, Hong HJ, Chung MW, Cho SB, Park CH, Joo YE, Kim HS, Choi SK, Rew JS. Risk factors for patients with stage IVB hepatocellular carcinoma and extension into the heart: prognostic and therapeutic implications. Yonsei Med J 2014; 55:379-86. [PMID: 24532507 PMCID: PMC3936619 DOI: 10.3349/ymj.2014.55.2.379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the risk factors of hepatocellular carcinoma (HCC) extension into the right atrium (RA) and determine poor prognostic factors for HCC extension to the heart. MATERIALS AND METHODS A total of 665 patients who were newly diagnosed with HCC were analyzed retrospectively from January 2004 to July 2012. The patients were divided into two groups: 33 patients with HCC extending into the RA and 632 HCC patients during the same period. The patients with HCC extending into the RA were subdivided into shorter survival group (<2 months) and longer survival group (≥2 months). RESULTS The prevalence of HCC extending to the RA was 4.96%. In multivariate analysis, a modified Union Internationale Contre le Cancer (UICC) stage higher than IVA, hepatic vein invasion, concomitant inferior vena cava and portal vein invasion, and multinodular tumor type were risk factors for HCC extending to the RA. In multivariate analysis, Cancer of the Liver Italian Program (CLIP) score>3 (p=0.016, OR: 13.89) and active treatment (p=0.024, OR: 0.054) were associated with prognostic factors in patients HCC extending into the RA. Active treatment such as radiation (n=1), transcatheter arterial chemoembolization (TACE) (n=11), Sorafenib (n=1), and combined modalities (n=2) were performed. CONCLUSION Modified UICC stage higher than IVA, vascular invasion and multinodular tumor type are independent risk factors for HCC extending to the RA. Active treatment may prolong survival in patients HCC extending into the RA.
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Affiliation(s)
- Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea.
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Wakayama K, Kamiyama T, Yokoo H, Kakisaka T, Kamachi H, Tsuruga Y, Nakanishi K, Shimamura T, Todo S, Taketomi A. Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium. World J Surg Oncol 2013; 11:259. [PMID: 24093164 PMCID: PMC3851861 DOI: 10.1186/1477-7819-11-259] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 09/20/2013] [Indexed: 02/08/2023] Open
Abstract
Background The prognosis for advanced hepatocellular carcinoma (HCC) with tumor thrombi in the inferior vena cava (IVC) or right atrium (RA) is poor, and there is no established effective treatment for this condition. Thus study aimed to evaluate the efficacy of surgical resection and prognosis after surgery for such cases. Methods Between January 1990 and December 2012, 891 patients underwent hepatectomy for HCC at our institution. Of these, 13 patients (1.5%) diagnosed with advanced HCC with tumor thrombi in the IVC or RA underwent hepatectomy and thrombectomy. Data detailing the surgical outcome were evaluated and recurrence-free and overall survival rates were calculated using the Kaplan-Meier method. Results Seven patients had an IVC thrombus and six had an RA thrombus. Extra-hepatic metastasis was diagnosed in 8 of 13 patients. Surgical procedures included three extended right lobectomies, three extended left lobectomies, five right lobectomies, and two sectionectomies. Right adrenal gland metastases were excised simultaneously in two patients. All IVC thrombi were removed under hepatic vascular exclusion and all RA thrombi were removed under cardiopulmonary bypass (CPB). Four patients (30.8%) experienced controllable postoperative complications, and there was no surgical mortality. The mean postoperative hospital stay for patients with IVC and RA thrombi was 23.6 ± 12.5 days and 21.2 ± 4.6 days, respectively. Curative resection was performed in 5 of 13 cases. The 1- and 3-year overall survival rates were 50.4%, and 21.0%, respectively, and the median survival duration was 15.3 months. The 1- and 3-year overall survival rates for patients who underwent curative surgical resection were 80.0% and 30.0%, respectively, with a median survival duration of 30.8 months. All patients who underwent curative resection developed postoperative recurrences, with a median recurrence-free survival duration of 3.8 months. The 1-year survival rate for patients who underwent noncurative surgery and had residual tumors was 29.2%, with a median survival duration of 10.5 months. Conclusions Aggressive surgical resection for HCC with tumor thrombi in the IVC or RA can be performed safely and may improve the prognoses of these patients. However, early recurrence and treatment for recurrent or metastatic tumors remain unresolved issues.
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Affiliation(s)
- Kenji Wakayama
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan.
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Dedeilias P, Nenekidis I, Koukis I, Anagnostakou V, Paparizou N, Zompolos S, Apostolakis E. Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium. J Cardiothorac Surg 2011; 6:102. [PMID: 21867564 PMCID: PMC3170317 DOI: 10.1186/1749-8090-6-102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/26/2011] [Indexed: 12/23/2022] Open
Abstract
We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases
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Affiliation(s)
- Panagiotis Dedeilias
- 1st Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece
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Abstract
A number of diseases may cause right atrial mass. Primary cardiac tumors range from 0.002 to 0.25%. Intracardiac manifestation and pulmonary embolism of hepatocellular carcinoma (HCC) is a very rare finding and uncommon even at autopsy. Here we describe the case of a 32-year-old Asian man who was referred for shortness of breath lasting for a month, along with unproductive cough. He was a manual laborer with a history of diabetes, alcoholism, and smoking. Clinically he was diagnosed as having pulmonary embolism. Echocardiogram showed a mass in the right atrium. Magnetic resonance imaging showed that he had a large mass in the right atrium extending down into the inferior vena cava. Further evaluation showed that he had chronic liver disease with portal hypertension and was hepatitis B surface antigen-positive, indicating hepatitis B infection. He underwent excision of the mass, and the pathological report showed metastasis of HCC with multiple vascular emboli in the lungs. As this is the second reported case of this kind in the literature, we highlight the need of screening at least 6-monthly all patients with chronic liver disease, hepatitis B and C virus infection for the early detection of HCC.
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Affiliation(s)
- C Rajasekharan
- Department of Medicine, Medical College Hospital, Thiruvanathapuram, India
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Kyokane T, Iyomasa S, Sawasaki N, Tojima Y, Goto H, Watanabe H, Takagi T, Matsuda M. A Case of Hepatocellular Carcinoma with Intra-atrial Tumor Thrombus Presenting Pulmonary Thromboemboli. ACTA ACUST UNITED AC 2010. [DOI: 10.5833/jjgs.43.398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lin HH, Hsieh CB, Chu HC, Chang WK, Chao YC, Hsieh TY. Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma complicated with tumor thrombi in the inferior vena cava: surgery or not? Dig Dis Sci 2007; 52:1554-7. [PMID: 17357843 DOI: 10.1007/s10620-006-9129-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 01/22/2006] [Indexed: 12/16/2022]
Affiliation(s)
- Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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