Conversion hepatectomy for hepatocellular carcinoma with main portal vein tumour thrombus after lenvatinib treatment: A case report

Figure 1 Images of hepatocellular carcinoma with portal vein tumour thrombus before lenvatinib treatment. A: Computed tomography image. An arrow indicates portal vein tumour thrombus; B: Three-dimensional image. The yellow mass demonstrates a viable portal vein tumour thrombus, extending to the contralateral third portal branch.

Figure 2 Images of hepatocellular carcinoma with portal vein tumour thrombus after lenvatinib treatment. A: Computed tomography image two weeks after the treatment. The portal vein tumour thrombus (PVTT) showed regression with partial disappearance of contrast enhancement; B: Computed tomography image three months after the treatment; C: Three-dimensional image three months after the treatment. The PVTT regressed to the contralateral first-order branch with loss of contrast enhancement. Arrows indicate PVTT.

Figure 3 Portal vein tumour thrombus thrombectomy. A: The right and the main portal veins were clamped by Satinsky forceps. Venotomy was placed at the bifurcation of the left portal vein; B: The portal vein tumour thrombus was thrombectomized; C: The left portal vein stump was closed by 6-0 proline.

Figure 4 Macroscopic and microscopic findings of the main tumour and the portal vein tumour thrombus. A: A white to brownish nodule was found in the left portal vein (arrows). Inlet: close-up picture of the removed portal vein tumour thrombus; B: The primary lesion showed severe fibrotic change with haemosiderin deposition. In the fibrosis, the viable tumour cell nests (arrow) and the necrotic tumour lesions (arrowhead) were scattered; C: High magnification demonstrated moderately to poorly differentiated tumour cells; D: Most of the portal vein tumour thrombus showed necrotic changes.