Case Report
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World J Gastroenterol. Jun 14, 2013; 19(22): 3512-3516
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3512
Transarterial embolization of metastatic mediastinal hepatocellular carcinoma
Chia-Chang Chen, Hong-Zen Yeh, Chi-Sen Chang, Chung-Wang Ko, Han-Chung Lien, Chun-Ying Wu, Siu-Wan Hung
Chia-Chang Chen, Hong-Zen Yeh, Chi-Sen Chang, Chung-Wang Ko, Han-Chung Lien, Chun-Ying Wu, Department of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Siu-Wan Hung, Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Author contributions: Chen CC designed the research and drafted the article; Yeh HZ performed endosonographic biopsy to prove the diagnosis of metastatic mediastinal hepatocellular carcinoma and revised the manuscript; Chang CS was the attending physician for this patient, discussed the treatment plan with the patient, and revised the manuscript; Hung SW performed the transarterial embolization for the metastatic mediastinal hepatocellular carcinoma and wrote the technical aspect of the procedure; Ko CW, Lien HC and Wu CY gave intellectual advice and revised the manuscript.
Correspondence to: Siu-Wan Hung, MD, Department of Radiology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan. dr.cjchen@gmail.com
Telephone: +886-4-23592525 Fax: +886-4-23741331
Received: January 12, 2013
Revised: April 14, 2013
Accepted: April 18, 2013
Published online: June 14, 2013
Processing time: 153 Days and 11.6 Hours
Abstract

This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.

Keywords: Embolization; Hepatocellular carcinoma; Lymphatic metastasis; Endosonography; Mediastinal neoplasm

Core tip: This report presents a patient with metastatic hepatocellular carcinoma localized to his mediastinum. The metastatic tumor grew rapidly, with α-fetoprotein (AFP) elevation rates correlating with the size of the tumor and tumor growth. We used several sessions of transarterial embolization to control this metastatic tumor. After every successful intervention, the tumor had been stabilized and AFP levels were decreased significantly, resulting in a survival time of the patient that is much longer when compared to the mean survival times of others with similar diagnoses. Transarterial embolization could be an alternative treatment choice for patients with mediastinal metastasis of hepatocellular carcinoma.