1
|
Shroff N, Choi W, Elshikh M, Wong B, Bhargava P. Multimodality imaging approach in identifying invasive hepatocellular carcinoma. Clin Imaging 2023; 97:34-43. [PMID: 36889113 DOI: 10.1016/j.clinimag.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the 5th most common neoplasm and the 3rd leading cause of cancer related mortality worldwide. Early stages of the neoplasm may be treated curatively with liver resection or orthotopic liver transplant. However, HCC has a high propensity for vascular and locoregional invasion, which can preclude these treatment options. The portal vein is the most invaded structure, while other regional structures affected include the hepatic vein, inferior vena cava, gallbladder, peritoneum, diaphragm, and the gastrointestinal tract. Management of invasive and advanced stages of HCC includes modalities such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and systemic chemotherapy, which are non-curative and focus on relieving tumor burden and slowing progression. A multimodality imaging approach is effective in identifying areas of tumor invasion and distinguishing between bland and tumor thrombi. Due to implications in prognosis and management, it is imperative for radiologists to accurately identify imaging patterns of regional invasion by HCC and to distinguish between bland and tumor thrombus in cases of potential vascular invasion.
Collapse
Affiliation(s)
- Neel Shroff
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Woongsoon Choi
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Mohamed Elshikh
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Brian Wong
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America.
| |
Collapse
|
2
|
Herbst MK, Alday S, Ek K. Hepatocellular carcinoma with right atrial tumor thrombus. Am J Med Sci 2022; 364:e33-e34. [PMID: 35490707 DOI: 10.1016/j.amjms.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, USA.
| | - Santiago Alday
- University of Connecticut School of Medicine Internal Medicine Residency, Department of Internal Medicine, Farmington, CT, USA
| | - Kirsten Ek
- University of Connecticut School of Medicine, Department of Internal Medicine, Farmington, CT, USA
| |
Collapse
|
3
|
Chao WS, Shen CH, Luo SC, Wu FH, Wei HJ, Yu CL, Wu CC, Yen Y, P’eng FK. Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi. J Clin Med 2022; 11:jcm11082140. [PMID: 35456235 PMCID: PMC9025558 DOI: 10.3390/jcm11082140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor thrombus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.
Collapse
Affiliation(s)
- Wen-Shan Chao
- Department of Surgery, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City 42055, Taiwan;
| | - Ching-Hui Shen
- Departments of Anesthesiology, Taichung Veterans General Hospital, Taichung City 40705, Taiwan;
- Department of Anesthesiology, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Shao-Ciao Luo
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
| | - Feng-Hsu Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Nursing, Hung Kuang University, Taichung City 433304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525; Fax: +886-4-23595046
| | - Hao-Ji Wei
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Chu-Leng Yu
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Cheng-Chung Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Yun Yen
- Cancer Translation Research Center, Taipei Medical University, Taipei City 106, Taiwan;
| | - Fang-Ku P’eng
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| |
Collapse
|
4
|
Wu K, Travaline CE, Elliot L. Right Atrial Tumor Invasion: A Rare Presentation of Hepatocellular Carcinoma. Cureus 2022; 14:e22901. [PMID: 35399442 PMCID: PMC8986503 DOI: 10.7759/cureus.22901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
Metastatic hepatocellular carcinoma has been associated with a poor prognosis. Common areas of spread include the lungs, portal vein, and portal lymph nodes. Affected patients often have coexisting comorbidities, including cirrhosis, chronic hepatitis, and nonalcoholic fatty liver disease. Our case discusses a rare presentation of hepatocellular carcinoma that had spread to the right atrium, manifesting as acute heart failure in a patient with no history of liver disease. This case highlights the importance of recognizing unusual presentations of advanced hepatocellular carcinoma, as earlier detection can lead to improved patient outcomes.
Collapse
|
5
|
Gomez-Puerto D, Mirallas O, Vidal-González J, Vargas V. Hepatocellular carcinoma with tumor thrombus extends to the right atrium and portal vein: A case report. World J Hepatol 2020; 12:1128-1135. [PMID: 33312435 PMCID: PMC7701967 DOI: 10.4254/wjh.v12.i11.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/23/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most important primary malignant liver disease. A large proportion of patients with advanced HCC have macrovascular invasion. HCC tends to infiltrate vascular structures, particularly the portal vein and its branches, and more rarely, the hepatic veins. The intravascular tumor thrombus can affect the inferior vena cava (IVC) or even the right atrium (RA), the latter having a poor prognosis.
CASE SUMMARY HCC is one of the most aggressive malignant tumors. Tumor thrombus (TT) formation in advanced HCC stages is common and usually involves the hepatic or portal veins. Herein, we report a 69-year-old woman who presented with dyspnea to the emergency department. A ventilation/perfusion lung scan was performed, ruling out pulmonary embolism. Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography, but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging. Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA. HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.
CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis. There is no consensus about anticoagulation or other interventions in these patients.
Collapse
Affiliation(s)
- Diego Gomez-Puerto
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Oriol Mirallas
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | | | - Victor Vargas
- Liver Unit, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
| |
Collapse
|
6
|
Mavroudis A, Cholongitas E. Long-Term Survival under Arterial Chemoembolization and Sorafenib of a Patient with Hepatocellular Carcinoma and Tumor Atrial Thrombus: A Case Report and Literature Review. Gastrointest Tumors 2020; 7:156-162. [PMID: 33173780 DOI: 10.1159/000509186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is considered to be the fourth most frequent cause of cancer-associated death globally. HCC might be associated, especially in advanced stages, with the formation of tumor thrombus (TT), which can be located in the portal vein, as well as in hepatic and/or inferior vena cava (IVC) veins. Nevertheless, the extension of TT to the right atrium (RA) is infrequent with an unfavorable prognosis. We present a rare case of a male patient with HCC and IVC TT extending to the RA. The atrial thrombus was the first manifestation of HCC diagnosed by cardiac ultrasound. So far, the patient has undergone 4 courses of transarterial chemoembolization in combination with systemic therapy with sorafenib, and under this therapeutic approach long-term survival has been achieved.
Collapse
Affiliation(s)
- Andreas Mavroudis
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
7
|
Abstract
BACKGROUND Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis. METHODS By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t, Fisher exact and I2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care. RESULTS The overall survival rate of this cohort was 40.8 %. The survival rate of patients receiving TACE was 33.3 % and that of surgical patients was 41.9 %. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7 ± 16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major morbidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care > radiotherapy > surgery > TACE > interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports. CONCLUSIONS Advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy. Based on the results of median survival time, radiotherapy and TACE seemed to be associated with an improved prognosis and possible better survival.
Collapse
|
8
|
Girardet R, Boughdad S, Digklia A, Beigelman C, Meyer M, Schaefer N, Vermersch M, Hocquelet A, Tsoumakidou G, Denys A, Duran R. Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium. Cardiovasc Intervent Radiol 2020; 43:1712-1715. [PMID: 32761249 PMCID: PMC7591430 DOI: 10.1007/s00270-020-02605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Hepatocellular carcinoma (HCC) has the tendency to invade the portal and/or hepatic venous system. The invasion of the right atrium is uncommonly observed and constitutes a treatment challenge. We report the case of a patient with HCC invading the right atrium treated with 90Yttrium-transarterial radioembolization (90Y-TARE). Following the treatment, organizing pneumonia secondary to nivolumab occurred, raising the question of an interaction between 90Y-TARE and nivolumab.
Collapse
Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Catherine Beigelman
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Marie Meyer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mathilde Vermersch
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| |
Collapse
|
9
|
Aly R, Gupta S, Gupta R, Jorge VM, Ebraheem A. Hepatocellular Carcinoma Presenting With Inferior Vena Cava Tumor Thrombus Extending to the Right Atrium: A Case Report. Cureus 2020; 12:e9421. [PMID: 32754419 PMCID: PMC7387077 DOI: 10.7759/cureus.9421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver tumor, and its incidence has been on the rise worldwide. It is a common cause of cancer-related death. HCC carries a poor prognosis and is challenging to manage, especially when diagnosed in advanced stages. We present a rare case of HCC in liver cirrhosis secondary to viral hepatitis C (HCV) infection, presenting with large tumor thrombus extending to the right atrium treated with lenvatinib.
Collapse
|
10
|
Zhang Y, Wu Z, Wang K, Han S, Li C, Li X. Long-term survival after anterior approach right hepatectomy combined with inferior vena cava thrombectomy using trans-diaphragmatic intrapericardial inferior vena cava occlusion: a case report and review of the literature. BMC Surg 2019; 19:122. [PMID: 31455319 PMCID: PMC6712705 DOI: 10.1186/s12893-019-0568-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Presence of inferior vena cava tumor thrombosis (IVCTT) is an unfavorable factor to prognosis for patients with hepatocellular carcinoma (HCC). Case presentation Herein we report a case of HCC with IVC tumor thrombosis extending from the right hepatic vein (RHV) to the IVC, but it had not infiltrated the right atrium. Anterior approach right hepatectomy combined with IVC thrombectomy using trans-diaphragmatic IVC occlusion was performed for this patient. The patient is alive with disease-free at 32 months after treatment. A literature review was also performed. This case was demonstrated with the details and concepts of surgery. Conclusion This case suggested that surgical resection of HCC involving the IVC, but still outside the right atrium (RA), could offer satisfactory surgical outcomes in selected patients.
Collapse
Affiliation(s)
- Yaodong Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Zhengshan Wu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Sheng Han
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Changxian Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Xiangcheng Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.
| |
Collapse
|
11
|
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Tumor thrombus formation in advanced HCC stages is common and usually involves the hepatic or portal veins. The formation of tumor thrombus is considered a poor prognostic factor. Herein, we report a rare case wherein the thrombus extended to the inferior vena cava (IVC) reaching the right atrium without affecting the hemodynamic status. This is a 59-year-old male who presented with melena. He was found to have grade 3 esophageal varices with findings suggestive of recent bleeding associated with a large amount of blood in the gastric body that required banding. Computed tomography (CT) of the abdomen and pelvis showed multiple liver masses with an intraluminal IVC mass extending from the hepatic vein into the right atrium. A CT scan of the chest confirmed the presence of a tumor thrombus in the IVC extending to the right atrium. The patient declines surgical intervention and he was discharged. Unfortunately, he passed after a short period of time. In conclusion, tumor thrombus formation is common in HCC. However, expansion of the thrombus to IVC and right atrium is rare and indicates poor prognosis.
Collapse
Affiliation(s)
- Laith Numan
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Samia Asif
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | | |
Collapse
|
12
|
Ariizumi SI, Kikuchi C, Tokitou F, Yamashita S, Kotera Y, Omori A, Kato T, Nemoto S, Niinami H, Yamamoto M. Cavo-atrial thrombectomy prior to hepatectomy for hepatocellular carcinoma with tumor thrombus in the right atrium: a case report. Surg Case Rep 2019; 5:57. [PMID: 30972512 PMCID: PMC6458225 DOI: 10.1186/s40792-019-0620-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in the right atrium is a critical condition. The general consensus is to perform hepatectomy prior to cavo-atrial thrombectomy because of the risk of uncontrollable bleeding during the liver transection after heparinization. However, sudden cardiac arrest due to the ball-valve effect and pulmonary embolism have been reported in cases of TT. Cavo-atrial thrombectomy prior to hepatectomy for HCC with TT in the right atrium was successfully performed to prevent sudden cardiac arrest and pulmonary embolism. CASE PRESENTATION Tumor thrombectomy under cardiopulmonary bypass with heparin and electrical ventricular fibrillation prior to hepatectomy was successfully performed to prevent sudden cardiac arrest or pulmonary embolism in a 75-year-old woman with a huge HCC and TT in the right atrium. After the neutralization of heparin, right hepatectomy with tumor thrombectomy in the inferior vena cava was performed. The total operation time was 9 h, and the total blood loss was 8200 mL. The patient's postoperative course was uneventful, and she was discharged 14 days after surgery. One year after surgery, she is alive with HCC recurrence in the lung. CONCLUSIONS Cavo-atrial thrombectomy prior to hepatectomy for HCC with TT in the right atrium can be performed safely to prevent sudden cardiac arrest and pulmonary embolism by collaboration of cardiovascular surgeons and gastroenterological surgeons.
Collapse
Affiliation(s)
- Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Chizuo Kikuchi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumiaki Tokitou
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Takaaki Kato
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Satoshi Nemoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan.
| |
Collapse
|
13
|
Habib S, Azam M, Siddiqui AH, Rajdev K, Chalhoub M. Hepatocellular Carcinoma After Successful Treatment of Hepatitis C Virus with Ledipasvir/Sofosbuvir Presenting as Acute Pulmonary Tumor Embolism. Cureus 2019; 11:e4336. [PMID: 31187001 PMCID: PMC6541161 DOI: 10.7759/cureus.4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hepatitis C virus (HCV)-induced cirrhosis is a major cause of hepatocellular carcinoma (HCC) worldwide. HCC is an aggressive malignancy in which tumor thrombus can invade portal vein, hepatic veins and inferior vena cava (IVC) in the later stages. Our case brings to attention, HCV patient population who might need long-term follow-up to ensure HCV clearance. Physicians should ensure appropriate follow-up after treatment of HCV and should emphasize on the ongoing screening for HCC in patients with cirrhosis or advanced fibrosis, regardless of antiviral treatment outcome.
Collapse
Affiliation(s)
- Saad Habib
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Mohammed Azam
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Abdul Hasan Siddiqui
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Kartikeya Rajdev
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Michel Chalhoub
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| |
Collapse
|
14
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
15
|
He C, Zhou Z, Xiao Z, Wang J. Treatment strategy for huge hepatocellular carcinoma with intrahepatic metastasis and macrovascular invasion: a case report and literature review. J Cancer Res Ther 2019; 14:S1233-S1236. [PMID: 30539879 DOI: 10.4103/0973-1482.204845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Macrovascular invasion, such as tumor thrombus in the major portal vein (mPVTT) or major hepatic vein (mHVTT), is regarded as indicative of an advanced stage of hepatocellular carcinoma (HCC). To date, no effective treatment has been established for this kind of HCC. We herein present a case of huge HCC with intrahepatic metastasis, mPVTT, and mHVTT. The patient was successfully treated with surgical resection-based multidisciplinary treatment. The clinical presentation, treatment strategy, and outcome of this case were presented.
Collapse
Affiliation(s)
- Chuanchao He
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhenyu Zhou
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiyu Xiao
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie Wang
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
16
|
Sempokuya T, Bolger DT. Right Atrium Invasion of Tumor Thrombus from Hepatocellular Carcinoma Incidentally Found on Transthoracic Echocardiogram. Hawaii J Med Public Health 2018; 77:131-134. [PMID: 29888115 PMCID: PMC5993993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hepatocellular carcinoma (HCC) is a highly aggressive malignancy in which tumor thrombus can invade portal and hepatic veins in late stages. However, an antemortem diagnosis of right atrial invasion by tumor thrombus is very rare and confers a poor prognosis. We report a patient with antemortem diagnosis of tumor thrombus in the right atrium incidentally found by transthoracic echocardiogram which was later confirmed with CT scan of abdomen with IV contrast. The patient was also noted to have an acute increase in alpha-fetoprotein (AFP). Our case suggests the importance of imaging studies and monitoring AFP levels in patients with long standing HCC.
Collapse
Affiliation(s)
- Tomoki Sempokuya
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, The Queen's Medical Center, Honolulu, HI
| | - Dennis T Bolger
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, The Queen's Medical Center, Honolulu, HI
| |
Collapse
|
17
|
Pandit N, Jaiswal LS, Shrestha V, Awale L, Adhikary S. Undifferentiated embryonal sarcoma of liver in an adult with spontaneous rupture and tumour thrombus in the right atrium. ANZ J Surg 2018; 89:E396-E397. [PMID: 29785758 DOI: 10.1111/ans.14670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Narendra Pandit
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Lokesh S Jaiswal
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Vijay Shrestha
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Lalijan Awale
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Shailesh Adhikary
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| |
Collapse
|
18
|
Zhang B, Zhang B, Zhang Z, Huang Z, Chen Y, Chen M, Bie P, Peng B, Wu L, Wang Z, Li B, Fan J, Qin L, Chen P, Liu J, Tang Z, Niu J, Yin X, Li D, He S, Jiang B, Mao Y, Zhou W, Chen X. 42,573 cases of hepatectomy in China: a multicenter retrospective investigation. Sci China Life Sci 2018; 61:660-670. [PMID: 29417360 DOI: 10.1007/s11427-017-9259-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023]
Abstract
Hepatectomy is currently routinely performed in most hospitals in China. China owns the largest population of liver diseases and the biggest number of liver resection cases. A nationwide multicenter retrospective investigation involving 112 hospitals was performed, and focused on liver resection for patients with hepatocellular carcinoma (HCC). 42,573 cases of hepatectomy were enrolled, and 18,275 valid cases of liver resection for HCC patients were selected for statistical analysis. The epidemiology of HCC, distribution of hepatectomy, postoperative complications and prognosis were finally analyzed. In the 18,275 HCC patients, 81% had hepatitis B virus infection and 10% had hepatitis C virus infection. 38% of the HCC patients had normal Alphafetoprotein (AFP) level, and other 35% had an AFP level lower than 400 ng mL-1. In the study period, 97% of the hepatectomy for HCC were treated with open surgery, and 23.81% had vascular exclusion techniques. The operation time was (191.7±105.6) min, the blood loss was (546.0±562.8) mL, and blood transfusion was (543.0±1,035.2) mL. The median survival for HCC patients was 631 days, with 1-, 3-, and 5-year overall survival of 73.2%, 28.8% and 19.6%, respectively. Liver cirrhosis, multiple nodules, tumor thrombosis and high AFP level were risk factors that affect postoperative survival.
Collapse
Affiliation(s)
- Binhao Zhang
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bixiang Zhang
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiwei Zhang
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiyong Huang
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yifa Chen
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Minshan Chen
- Cancer Hospital of Sun Yat-sen University, Guangzhou, 510060, China
| | - Ping Bie
- Southwest Hospital, Chongqing, 400038, China
| | - Baogang Peng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Liqun Wu
- Affiliated Hospital of Qingdao Medical College, Qingdao, 266071, China
| | | | - Bo Li
- West China Hospital, Chengdu, 610041, China
| | - Jia Fan
- Zhongshan Hospital of Fudan University, Shanghai, 200032, China
| | - Lunxiu Qin
- Huashan Hospital of Fudan University, Shanghai, 100044, China
| | - Ping Chen
- Daping Hospital, the Third Military Medical University, Chongqing, 400042, China
| | - Jingfeng Liu
- Mengchao Hepatobiliary Hospital, Fuzhou, 350025, China
| | - Zhe Tang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jun Niu
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xinmin Yin
- Hunan People's Hospital, Changsha, 410002, China
| | - Deyu Li
- Henan People's Hospital, Zhengzhou, 450003, China
| | - Songqing He
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Bin Jiang
- Taihe Hospital, Shiyan, 442000, China
| | - Yilei Mao
- Union Hospital, Beijing, 100032, China.
| | - Weiping Zhou
- Eastern Hepatobiliary Surgery Hospital, Shanghai, 201805, China.
| | - Xiaoping Chen
- Institute of Hepato-pancreato-bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
19
|
Azzam AZ, Azzam KA. Hepatocellular Carcinoma Migrating to the Right Atrium through the Inferior Vena Cava. Sultan Qaboos Univ Med J 2018; 18:e118-e119. [PMID: 29666697 PMCID: PMC5892805 DOI: 10.18295/squmj.2018.18.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/14/2018] [Accepted: 01/25/2018] [Indexed: 02/05/2023] Open
Abstract
Interesting Medical Image
Collapse
Affiliation(s)
- Ayman Z. Azzam
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Corresponding Author’s e-mail:
| | - Kareem A. Azzam
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| |
Collapse
|
20
|
Takaya H, Kawaratani H, Seki K, Okura Y, Kitade M, Namisaki T, Sawai M, Sawada Y, Kubo T, Mitoro A, Yamao J, Yoshiji H. A Patient with Hepatocellular Carcinoma with Isolated Right Atrial Metastases. Intern Med 2017; 56:2589-2594. [PMID: 28883235 PMCID: PMC5658524 DOI: 10.2169/internalmedicine.8568-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma (HCC) with isolated right atrial metastasis is extremely rare; most cases are considered inoperable. We herein report the case of a 74-year-old man with HCC with isolated right atrial metastases without hepatic vein invasion; the right atrial lesion was resected because of the risk of heart failure and sudden death. Postoperatively, he underwent transcatheter arterial chemoembolization and radiofrequency ablation for intrahepatic HCC. He recovered completely, with a long-term survival of 36 months. This is the first report of an HCC patient with isolated right atrial metastases without hepatic vein invasion. Tumorectomy for solitary atrial metastasis is effective for HCC patients.
Collapse
Affiliation(s)
- Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Hideto Kawaratani
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Kenichiro Seki
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Yasushi Okura
- Department of Endoscopy, Nara Medical University, Japan
| | - Mitsuteru Kitade
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Masayoshi Sawai
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Takuya Kubo
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, Japan
| | - Junichi Yamao
- Department of Endoscopy, Nara Medical University, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Japan
| |
Collapse
|
21
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
22
|
Ohta M, Nakanishi C, Kawagishi N, Hara Y, Maida K, Kashiwadate T, Miyazawa K, Yoshida S, Miyagi S, Hayatsu Y, Kawamoto S, Matsuda Y, Okada Y, Saiki Y, Ohuchi N. Surgical resection of recurrent extrahepatic hepatocellular carcinoma with tumor thrombus extending into the right atrium under cardiopulmonary bypass: a case report and review of the literature. Surg Case Rep 2016; 2:110. [PMID: 27726114 PMCID: PMC5056913 DOI: 10.1186/s40792-016-0241-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Recurrent hepatocellular carcinoma accompanied by a right atrial tumor thrombus is rare. No standard treatment modality has been established. Surgical treatment may be the only curative treatment; however, surgery has been considered high risk. We herein describe a patient who underwent resection of a recurrent right atrial tumor thrombus under normothermic cardiopulmonary bypass on a beating heart. Case presentation A 60-year-old man underwent a right hepatectomy for hepatocellular carcinoma with diaphragm invasion. During the preoperative cardiac screening, he was diagnosed with an old myocardial infarction with triple-vessel coronary disease. Percutaneous coronary intervention was performed for the left anterior descending artery and left circumflex coronary artery. High-grade stenosis remained in his right coronary artery. Nine months later, computed tomography showed recurrent hepatocellular carcinoma in the diaphragm and a tumor thrombus extending from the suprahepatic inferior vena cava into the right atrium. Surgical resection of the recurrent tumor was performed through a right subcostal incision with xiphoid extension and median sternotomy. The recurrent tumor was incised with the diaphragm and pericardium. Intraoperative ultrasonography revealed that the tumor thrombus was free from right atrium wall invasion and that the right atrium could be clamped just proximal to the tumor thrombus. The right atrium, infrahepatic vena cava, left and middle hepatic veins, and hepatoduodenal ligament were encircled. Cardiopulmonary bypass was performed to prevent ischemic heart disease caused by intraoperative hypotension. Total hepatic vascular exclusion was then performed under normothermic cardiopulmonary bypass on heart beating. The inferior vena cava wall was incised. The tumor thrombus with the diaphragmatic recurrent tumor was resected en bloc. The patient had a favorable clinical course without any complications. Conclusion The recurrent hepatocellular carcinoma in the diaphragm and the right atrial tumor thrombus were safely resected using normothermic cardiopulmonary bypass on heart beating.
Collapse
Affiliation(s)
- Mineto Ohta
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Kai Maida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Toshiaki Kashiwadate
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Koji Miyazawa
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Satoru Yoshida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yukihiro Hayatsu
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasushi Matsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| |
Collapse
|
23
|
Topcu S, Gülcü O, Aksu U, Aksakal E. A rare life-threatening condition: metastasis to the heart. Am J Emerg Med 2016; 34:1912.e3-4. [PMID: 26922641 DOI: 10.1016/j.ajem.2016.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/01/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Selim Topcu
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Uğur Aksu
- Department of Cardiology, Kars State Hospital, Kars, Turkey.
| | - Enbiya Aksakal
- Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| |
Collapse
|