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Vicenty-Rivera S, Molina-Lopez VH, Rodriguez AP. Cardiac Hepatoma: An Unlikely Cause of Malignant Cardiac Metastatic Disease. Cureus 2024; 16:e69202. [PMID: 39345809 PMCID: PMC11436280 DOI: 10.7759/cureus.69202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 10/01/2024] Open
Abstract
Cardiac hepatoma is an extremely rare presentation of tumor metastasis. We present a case of an 80-year-old male who presented with symptoms of heart failure and was subsequently diagnosed with cardiac metastatic tumors. This case report highlights the diagnostic challenges and management options associated with this rare entity.
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Kushiya H, Ambo Y, Takada M, Masuda T, Naraoka S, Hirano S. Right hepatectomy under cardiopulmonary bypass for hepatocellular carcinoma with inferior vena cava tumor thrombus: a case report. Surg Case Rep 2023; 9:175. [PMID: 37789134 PMCID: PMC10547666 DOI: 10.1186/s40792-023-01756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The prognosis of hepatocellular carcinoma (HCC) with vascular invasion is extremely poor, especially in patients with tumor thrombus (TT) of the inferior vena cava (IVC), which is an oncological emergency with a high risk of sudden death due to TT extension or migration. Herein, we describe a case of HCC with TT of the IVC that rapidly extended into the right atrium (RA), in which right hepatectomy was performed under cardiopulmonary bypass. CASE PRESENTATION A 64-year-old man was diagnosed with HCC with IVC TT, and right hepatic lobectomy was scheduled. While awaiting surgery, he complained of respiratory distress and rushed to the emergency room. The TT had reached the RA, and the patient was in a state of oncologic emergency. We requested the cooperation of the cardiovascular surgery department, and under artificial cardiopulmonary support, the right atrium was incised, and a part of the TT was removed. The IVC was clamped to prevent tumor dispersal, and right hepatic lobectomy was performed. The remaining thrombus was excised along with the right lobe of the liver by incising the IVC. There were no serious postoperative complications, and the patient is alive 1 year and 5 months postoperatively. CONCLUSION Hepatic resection with cardiopulmonary bypass could be an option for HCC with TT reaching the RA.
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Affiliation(s)
- Hiroki Kushiya
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan.
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yoshiyasu Ambo
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Minoru Takada
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Takahiko Masuda
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Shuichi Naraoka
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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3
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Tathireddy H, Rice D, Martens K, Shivakumar S, Shatzel J. Breaking down tumor thrombus: Current strategies for medical management. Thromb Res 2023; 230:144-151. [PMID: 37722206 PMCID: PMC11027429 DOI: 10.1016/j.thromres.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.
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Affiliation(s)
- Harsha Tathireddy
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Douglas Rice
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Joseph Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, OR, USA
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4
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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: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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.
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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
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5
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Dantas E, Matos D, Coelho M, Sequeira C, Cardoso C, Oliveira AP. Hepatocellular Carcinoma with Atrial Extension: A Case Report. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:360-363. [PMID: 34604468 DOI: 10.1159/000511643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma is a common malignancy usually associated with cirrhosis. Despite being a highly aggressive tumor with several cases of vascular invasion, metastatic disease to the heart is a rare condition. A 65-year-old male cirrhotic patient was admitted with dyspnea, ascites, and lower extremity edema. A transthoracic echocardiogram showed a large mass in the right atrium. Further imaging studies revealed the presence of hepatocellular carcinoma extending from the liver to the right atrium through the inferior vena cava. The cardiac mass was surgically removed to treat the symptoms of right heart failure, but unfortunately the patient died on the 30th day after surgery due to septic shock.
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Affiliation(s)
- Eduardo Dantas
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Daniel Matos
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mariana Coelho
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cristiana Sequeira
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cláudia Cardoso
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Paula Oliveira
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/05/2021] [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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7
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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8
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Zhang ZY, Zhang EL, Zhang BX, Chen XP, Zhang W. Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava: A comprehensive review. World J Gastrointest Surg 2021; 13:796-805. [PMID: 34512903 PMCID: PMC8394384 DOI: 10.4240/wjgs.v13.i8.796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of liver cancer with a high mortality rate worldwide. The percentage of HCC patients with vascular invasion is high. However, tumor thrombus in the hepatic vein (HVTT) has a lower incidence than tumor thrombus in the portal vein (PVTT). Conventionally, HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents. However, according to recent studies, it is evident that HCC with HVTT shows different outcomes when classified into different subgroups. In this review, we discuss the recent progress and changes in treatment of HCC with HVTT.
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Affiliation(s)
- Zun-Yi Zhang
- Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
| | - Er-Lei Zhang
- Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
| | - Bi-Xiang Zhang
- Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
| | - Xiao-Ping Chen
- Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
| | - Wei Zhang
- Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
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9
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Hepatocellular carcinoma with right atrial tumor thrombus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 59:153-161. [PMID: 33152793 DOI: 10.1055/a-1275-3780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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.
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10
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Xia Y, Zhang J, Ni X. Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus. Oncol Lett 2020; 20:101. [PMID: 32831920 PMCID: PMC7439153 DOI: 10.3892/ol.2020.11962] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
Although tumor thrombus (TT) infringement of the inferior vena cava (IVC) and right atrium (RA) is rarely observed in hepatocellular carcinoma (HCC), the prognosis for this condition is extremely poor, with a median survival time of several months, given that the condition is often diagnosed at an advanced tumor stage or combined with multiple systemic metastases. Furthermore, there is no established effective treatment for the condition. However, some investigators insist that active treatment, including surgery, chemotherapy (systemic or intra-arterial), radiation therapy, best supportive care or a combination of these, may help prolong overall survival time in these patients. The management of patients with advanced HCC and a TT extending into the RA and IVC is extremely difficult and risky. To this end, the present review assessed the literature on the clinical features and treatments of this condition in recent years, with the aim of providing assistance for clinical work.
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Affiliation(s)
- Yinchuan Xia
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Junqi Zhang
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Xiaoling Ni
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
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11
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Ultrasonographic assessment of right heart intracardiac mass in patients with hepatitis B virus infection. Eur J Gastroenterol Hepatol 2020; 32:838-843. [PMID: 31725029 DOI: 10.1097/meg.0000000000001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The characteristics of right heart intracardiac mass in hepatitis B virus infection patients are not well known. Our aim is to describe their ultrasonographic features and nature of such masses. METHODS We retrospectively reviewed imaging reports of hepatitis B virus infection patients from January 2014 to December 2018. Patients with a confirmed finding of right heart intracardiac mass were included, whose pathology reports and contrast-enhanced images were analyzed. Various masses were compared to a general control group from a published study. RESULTS Thirty-eight cases were finally included. Different types of masses presented with a variety of echocardiographic manifestations. Thirty-six cases had masses located in the right atrium, including five thrombus and 31 metastatic carcinoma. The later included one metastatic non-Hodgkin lymphoma and 30 metastatic hepatic carcinoma cases (27 of which had inferior vena cava tumor thrombus). Two cases presented with masses in the right ventricle that included one multiple myxoma and one tricuspid valve leaflet vegetation. Compared with the general population, no primary malignant tumor was found in our study (65% vs. 100%, P = 0.001), and hepatic metastasis was the most common type of malignant tumors (P < 0.001). CONCLUSION The nature and ultrasonographic features of right heart intracardiac masses in hepatitis B virus infection patients are diverse, and the incidence of malignant tumors was similar to that seen in the general population. Hepatic metastasis, possibly extending via the inferior vena cava into the right atrium, was the most common type. Our study may improve understanding of the right heart intracardiac mass in hepatitis B virus infection patients.
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12
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Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients. J Clin Med 2020; 9:jcm9041100. [PMID: 32290567 PMCID: PMC7231159 DOI: 10.3390/jcm9041100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Methods: Tumors infiltrating the inferior caval vein (ICV) have been considered irresectable in the past due to high perioperative risks. Consequently, the only treatment option for these patients was best supportive care, which resulted in reduced survival. Advancements in surgical techniques have since evolved, such that combined resections of the ICV and the hepatic malignancy are being performed. The aim of this study was the evaluation of the long-term outcomes (e.g., survival) and short-term risks of this procedure. In this single-center, retrospective cohort study (n = 24), we evaluated surgical and oncological outcome for patients undergoing hepatic surgery for oncological indications in combination with resections of the ICV. In addition, we investigated which factors are associated with survival. Results: First, we showed that perioperative mortality is as low as 4.1%. Second, we showed that perioperative co-morbidities are acceptable for this type of advanced hepatobiliary surgery. Third, the reconstruction of the ICV by means of a patch was superior in terms of survival compared to other types of reconstructions. This finding was independent of the type or the aggressiveness of tumor or the resections status. Discussion: In our cohort, many patients had undergone (multiple) preceding visceral surgical interventions or underwent multi-visceral surgery. Despite the medical complexity, survival was encouraging in this cohort, offering novel treatment modalities with a low risk of severe morbidities.
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13
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Aiello VD, Tanigawa RY, Chate RC, de Campos FPF, Mansur AJ. Progressive dyspnea and a right atrial mass in an 80-year-old man. Autops Case Rep 2019; 9:e2019135. [PMID: 31807438 PMCID: PMC6880769 DOI: 10.4322/acr.2019.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases.
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Affiliation(s)
- Vera Demarchi Aiello
- Universidade de São Paulo (USP), Medical School, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Ryan Yukimatsu Tanigawa
- Universidade de São Paulo (USP), Medical School, Department of Pathology. São Paulo, SP, Brazil
| | - Rodrigo Caruso Chate
- Universidade de São Paulo (USP), Medical School, Hospital das Clínicas, Division of Radiology. São Paulo, SP, Brazil
| | | | - Alfredo José Mansur
- Universidade de São Paulo (USP), Medical School, Heart Institute, General Outpatient Clinics, Division of Clinical Cardiology. São Paulo, SP, Brazil
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14
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Abdelnabi M, Almaghraby A, Saleh Y, Abd Elsamad S. Hepatocellular carcinoma with a direct right atrial extension in an HCV patient previously treated with direct-acting antiviral therapy: a case report. Egypt Heart J 2019; 71:5. [PMID: 31659529 PMCID: PMC6821414 DOI: 10.1186/s43044-019-0012-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is considered the third-leading cause of cancer-related mortality worldwide. Most cases of HCC are usually associated with liver cirrhosis due to various causes such as alcohol or more commonly viral hepatitis. Usually, patients remain asymptomatic for a long time, and symptoms are usually related to the cirrhosis itself or secondary to tumor extension. Intra-cardiac involvement with HCC rarely develops with a very poor prognosis. The occurrence and recurrence of HCC in cirrhotic patients treated with direct-acting antiviral (DAA) therapy (sofosbuvir) have been discussed in a few trials so far with no valid answer. CASE PRESENTATION We are reporting a case of recurrent HCC with an accidentally discovered direct right atrial extension with tumor thrombus through the inferior vena cava (IVC) in a cirrhotic patient previously treated with DAA. Unfortunately, due to his critical general condition, he died within days. CONCLUSION Cardiac involvement in HCC rarely occurs and usually develops in advanced stages of HCC with very poor reported prognosis. Data regarding the relation between DAA and HCC development is controversial.
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Affiliation(s)
- Mahmoud Abdelnabi
- Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, University of Alexandria, 165 El-Horeya Rd, Al Ibrahimeyah Qebli WA Al Hadrah Bahri, Qesm Bab Sharqi, Alexandria Governorate, 21561 Egypt
| | - Abdallah Almaghraby
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Yehia Saleh
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
- Michigan State University, East Lansing, MI USA
| | - Sherif Abd Elsamad
- Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, University of Alexandria, 165 El-Horeya Rd, Al Ibrahimeyah Qebli WA Al Hadrah Bahri, Qesm Bab Sharqi, Alexandria Governorate, 21561 Egypt
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15
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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: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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.
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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
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16
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Li Y, Liu F, Yang L, Meng Y, Li A, Pan M. External-beam radiation therapy versus surgery in the treatment of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombi. Asia Pac J Clin Oncol 2019; 15:316-322. [PMID: 31309718 DOI: 10.1111/ajco.13194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Both surgery and external-beam radiotherapy are effective treatments for hepatocellular carcinoma (HCC) patients with inferior vena cava/right atrium (IVC/RA) tumor thrombi. At present, it is not clear which modality is more suitable. We therefore compared outcomes between surgery and radiotherapy for these patients. METHODS We retrospectively reviewed 108 HCC patients with IVC/RA tumor thrombi who were referred for surgery (n = 51) and external-beam radiotherapy (n = 57) at three institutions. Different surgical methods were selected according to the classification of the tumor thrombus. Radiotherapy was designed to focus on primary intrahepatic tumors and tumor thrombi. Predictors of time to progression (TTP) were identified by using univariate and multivariate analyses. RESULTS The median TTP was significantly longer in the radiotherapy group than in the surgery group (5.0 months vs 4.2 months; P = 0.010). The multivariate analysis revealed that independent factors predicting shorter TTP were treatment with surgery (HR = 0.577; 95% CI, 0.385-0.865; P = 0.008) and intrahepatic tumor size larger than 10 cm (HR = 0.561; 95% CI, 0.342-0.919; P = 0.022). The median survival times for the radiotherapy and surgery groups were 12.8 and 14.5 months, respectively; the two groups did not have a significant difference in survival (P = 0.466). CONCLUSIONS For HCC patients with IVC/RA tumor thrombi, treatment with external-beam radiotherapy and intrahepatic tumor size smaller than 10 cm may predict longer TTP. Compared with complicated surgery, radiotherapy, as a noninvasive treatment modality, may be more likely to be accepted.
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Affiliation(s)
- Yong Li
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.,Center of Radiation Oncology, Wujing Hospital, Shanghai, China
| | - Fenghua Liu
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Liang Yang
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Yan Meng
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Aijun Li
- Department of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Mianshun Pan
- Center of Radiation Oncology, Wujing Hospital, Shanghai, China
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17
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Kurokawa N, Kishimoto T, Tanaka K, Kondo J, Takahashi N, Miura Y. New approach to evaluating the effects of a drug on protein complexes with quantitative proteomics, using the SILAC method and bioinformatic approach. Biosci Biotechnol Biochem 2019; 83:2034-2048. [PMID: 31282289 DOI: 10.1080/09168451.2019.1637244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Protein-protein interactions (PPIs) lead the formation of protein complexes that perform biochemical reactions that maintain the living state of the living cell. Although therapeutic drugs should influence the formation of protein complexes in addition to PPI network, the methodology analyzing such influences remain to be developed. Here, we demonstrate that a new approach combining HPLC (high performance liquid chromatography) for separating protein complexes, and the SILAC (stable isotope labeling using amino acids in cell culture) method for relative protein quantification, enable us to identify the protein complexes influenced by a drug. We applied this approach to the analysis of thalidomide action on HepG2 cells, assessed the identified proteins by clustering data analyses, and assigned 135 novel protein complexes affected by the drug. We propose that this approach is applicable to elucidating the mechanisms of actions of other therapeutic drugs on the PPI network, and the formation of protein complexes.
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Affiliation(s)
- Natsuki Kurokawa
- Graduate School of Agriculture, Tokyo University of Agriculture & Technology , Fuchu-shi, Tokyo , Japan.,Innovative Research Division, Mitsubishi Tanabe Pharma Corporation , Chuo-ku , Japan
| | - Taro Kishimoto
- Innovative Research Division, Mitsubishi Tanabe Pharma Corporation , Chuo-ku , Japan
| | - Kohei Tanaka
- Innovative Research Division, Mitsubishi Tanabe Pharma Corporation , Chuo-ku , Japan
| | - Jun Kondo
- Innovative Research Division, Mitsubishi Tanabe Pharma Corporation , Chuo-ku , Japan
| | - Nobuhiro Takahashi
- Graduate School of Agriculture, Tokyo University of Agriculture & Technology , Fuchu-shi, Tokyo , Japan
| | - Yutaka Miura
- Graduate School of Agriculture, Tokyo University of Agriculture & Technology , Fuchu-shi, Tokyo , Japan
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18
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Lou J, Li Y, Liang K, Guo Y, Song C, Chen L, Wang L, Wang F, Zhang L, Chen X, Xu X, Pan M. Hypofractionated radiotherapy as a salvage treatment for recurrent hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: a multi-center analysis. BMC Cancer 2019; 19:668. [PMID: 31277593 PMCID: PMC6612212 DOI: 10.1186/s12885-019-5870-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recurrent hepatocellular carcinoma (HCC) with a tumor thrombus (TT) extending into the inferior vena cava (IVC)/right atrium (RA) is generally regarded as a terminal-stage condition and there is no worldwide consensus on the proper management of this situation. In the present study, we report the efficacy of hypofractionated radiotherapy (HFRT) as a salvage treatment for recurrent HCC with IVC/RA TT. Methods We retrospectively reviewed 75 HCC patients with an IVC/RA TT who were referred for HFRT at three institutions between 2008 and 2016. 57 cases had a TT located in the IVC (IVC group), and 18 cases had a TT located in the IVC and RA (IVC + RA group). HFRT was designed to focus on the TT with or without the primary intrahepatic tumors. Results In all cases, the TT completely disappeared (CR) in 17 patients (22.7%), 55 patients (73.3%) had a partial response (PR), and 3 patients (4.0%) had a stable disease (SD). There were no cases of progressive disease (PD). The 1-, 2-, and 3-year overall survival rates of the 75 patients were 38.7% (29/75), 13.3% (10/75) and 5.3% (4/75), respectively. The overall median survival time was 10 months. The mean survival times for the IVC group and IVC+ RA group were 13.8 ± 1.1 and 11.6 ± 2.5 months, respectively. There was no significant difference in survival between the two groups (p = 0.205). Log-rank test revealed that factors predicting poor survival were Child-Pugh B liver function classification, AFP ≥ 400 μg/L, intrahepatic multiple tumors, distant metastases, only the TT as the target, a biological effective dose (BED) < 55 Gy and no chance of further radiotherapy. Conclusions HFRT appears to be an effective and reasonable treatment option for recurrent HCC patients with IVC/RA TT. The location of the tumor thrombus, either in IVC or in IVC and RA, is not the factor that influences the efficacy of radiotherapy or survival.
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Affiliation(s)
- Jinrong Lou
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China
| | - Yong Li
- Center of Radiation Oncology, Wujing Hospital, 380 Hongxu Road, Shanghai, 201103, China
| | - Kangning Liang
- Center of Radiation Oncology, Wujing Hospital, 380 Hongxu Road, Shanghai, 201103, China
| | - Yutian Guo
- Center of Radiation Oncology, Wujing Hospital, 380 Hongxu Road, Shanghai, 201103, China
| | - Changlong Song
- Center of Radiation Oncology, Guangdong Nongken Central Hospital, 2 Renmin Road, Guangzhou, 524002, China
| | - Lei Chen
- Center of Radiation Oncology, Wujing Hospital, 380 Hongxu Road, Shanghai, 201103, China
| | - Lifang Wang
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China
| | - Fei Wang
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China
| | - Li Zhang
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China
| | - Xia Chen
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China
| | - Xiangdong Xu
- Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, 1 Chengbei Road, Shanghai, 201800, China.
| | - Mianshun Pan
- Center of Radiation Oncology, Wujing Hospital, 380 Hongxu Road, Shanghai, 201103, China.
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19
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Shin DS, Sandstrom CK, Ingraham CR, Monroe EJ, Johnson GE. The inferior vena cava: a pictorial review of embryology, anatomy, pathology, and interventions. Abdom Radiol (NY) 2019; 44:2511-2527. [PMID: 30937506 DOI: 10.1007/s00261-019-01988-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The inferior vena cava (IVC) is the largest venous conduit below the diaphragm. Although this structure is often overlooked both clinically and radiographically, it can be involved in many different pathologic processes. A thorough understanding of the IVC will assist the radiologist in recognizing anatomic variants, identifying abnormalities, and providing accurate differential diagnoses. In this comprehensive pictorial review of the IVC, we depict embryology behind anatomic variants, present a wide range of pathology with a focus on diagnostic imaging, and describe relevant endovascular interventions.
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Affiliation(s)
- David S Shin
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA.
| | - Claire K Sandstrom
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA
| | - Christopher R Ingraham
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA
| | - Eric J Monroe
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Guy E Johnson
- Department of Radiology, University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA
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20
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Akutsu Y, Kawamura M, Tanisawa H, Nomura K, Gokan T, Sekimoto T, Kaneko K, Kodama Y, Ohgiya Y, Matsuyama T, Gokan T, Shinke T. Intracardiac Thrombosis and Heart Failure in a Patient with Hepatocellular Carcinoma and Cardiac Amyloidosis and an Implanted Cardiac Resynchronization Therapy Device. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:933-936. [PMID: 31256189 PMCID: PMC6613491 DOI: 10.12659/ajcr.916672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device. CASE REPORT A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava. CONCLUSIONS Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis.
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Affiliation(s)
- Yasushi Akutsu
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Division of Internal Medicine (Cardiology), Clinical Research Center for Clinical Pharmacology and Therapeutics, Showa University School of Medicine, Tokyo, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hiroki Tanisawa
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kosuke Nomura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiko Gokan
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kyoichi Kaneko
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Kodama
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Takaaki Matsuyama
- Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takehiko Gokan
- Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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21
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Numan L, Asif S, Abughanimeh OK. Hepatocellular Carcinoma with Tumor Thrombus Extending from the Portal Vein to the Right Atrium. Cureus 2019; 11:e4689. [PMID: 31338266 PMCID: PMC6639066 DOI: 10.7759/cureus.4689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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.
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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
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22
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Birnbaum GD, Faza NN, Birnbaum Y. Hepatocellular Carcinoma Involving the Left Ventricle. Tex Heart Inst J 2019; 46:55-56. [PMID: 30833841 DOI: 10.14503/thij-17-6297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Iwamoto H, Nomiyama M, Niizeki T, Shimose S, Shirono T, Nakano M, Satani M, Okamura S, Noda Y, Kamachi N, Sakai M, Suzuki H, Kuromatsu R, Ogo E, Abe T, Tanaka M, Koga H, Torimura T. Dose and Location of Irradiation Determine Survival for Patients with Hepatocellular Carcinoma with Macrovascular Invasion in External Beam Radiation Therapy. Oncology 2019; 96:192-199. [PMID: 30650415 DOI: 10.1159/000495568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/19/2018] [Indexed: 12/28/2022]
Abstract
AIM Prognosis of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) is extremely poor. However, proper therapeutic strategies have not been established yet. The purpose of this study is to identify the effects of external beam radiation therapy (EBRT) for MVI of HCC. METHODS We have analyzed and evaluated 80 consecutive patients with HCC with MVI who underwent EBRT, and factors associated with enhanced survival in EBRT were evaluated by univariate and multivariate analysis. RESULTS The local response rate of radiotherapy for the irradiated MVI was 66.2%. The time to progression of the irradiated MVI was 5.8 months. Univariate and multivariate analyses showed that the higher irradiation dose (over 45 Gy) and the irradiation location (hepatic vein tumor thrombus - HVTT) were significant factors associated with survival benefits of EBRT. The response of EBRT for HVTT was significantly superior to that for portal vein or bile duct tumor thrombus. CONCLUSION We conclude that a multidisciplinary therapeutic strategy based on EBRT should be proactively selected in the treatment of advanced HCC with MVI.
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Affiliation(s)
- Hideki Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan, .,Division of Liver Cancer Research, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan, .,Iwamoto Medical Clinic, Kitakyusyu, Japan,
| | - Mika Nomiyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shigeo Shimose
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomotake Shirono
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masahito Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Manabu Satani
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Syusuke Okamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yu Noda
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Naoki Kamachi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Miwa Sakai
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Suzuki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryoko Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Masatoshi Tanaka
- Department of Internal Medicine, Yokokura Hospital, Omuta, Japan
| | - Hironori Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.,Division of Liver Cancer Research, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.,Division of Liver Cancer Research, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
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24
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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: 2.9] [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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25
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Salehi M, Yee T, Alatevi E, Thein Y. Clinically Silent Intracardiac Metastasis with Extremely Poor Prognosis in a Patient with Hepatocellular Carcinoma. Case Rep Gastroenterol 2017; 11:416-421. [PMID: 28878615 PMCID: PMC5566969 DOI: 10.1159/000477379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/28/2017] [Indexed: 11/26/2022] Open
Abstract
Intracavitary cardiac extension remains an unusual site of extrahepatic metastasis in patients with hepatocellular carcinoma. While patients can present with signs and symptoms suggestive of right-sided heart failure, it may be totally asymptomatic, which is very rare with only a few cases reported so far. Also, cardiac metastasis is of great prognostic importance as patients with intracardiac metastasis can have an extremely poor prognosis. Here, we present the case of a 52-year-old male patient with advanced hepatocellular carcinoma, with an incidentally found tumor thrombus extending from the inferior vena cava to the right atrium, protruding through the tricuspid valve into the right ventricle, on routine echocardiography. The patient did not have any signs or symptoms of heart involvement and unfortunately died on the 18th day of the hospital stay.
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Affiliation(s)
- Mashal Salehi
- Department of Medicine, NYC Health + Hospitals/Harlem, Columbia University, New York, NY, USA
| | - The Yee
- Department of Medicine, NYC Health + Hospitals/Harlem, Columbia University, New York, NY, USA
| | - Eric Alatevi
- Department of Medicine, NYC Health + Hospitals/Harlem, Columbia University, New York, NY, USA
| | - Yamin Thein
- Department of Medicine, NYC Health + Hospitals/Harlem, Columbia University, New York, NY, USA
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26
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Tsang J, Chan A, Chok K, Tsang F, Lo CM. Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2017; 16:329-333. [PMID: 28603104 DOI: 10.1016/s1499-3872(16)60111-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Albert Chan
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
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Alhawassi S. Rare Case of Hepatocellular Carcinoma Invading the Right Atrium. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:189-191. [PMID: 30787785 PMCID: PMC6298363 DOI: 10.4103/1658-631x.204872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sami Alhawassi
- Department of Surgery, Assistant Consultant in General Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
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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: 0.5] [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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Komarov RN, Alikhanov RB, Chernyavskiy SV, Kim PP, Yavorovskiy AG, Goloshchapov-Aksenov RS. [Left hemihepatectomy with thrombectomy from inferior vena cava and right atrium under cardiopulmonary bypass in patient with hepatocellular carcinoma]. Khirurgiia (Mosk) 2017:82-84. [PMID: 29186103 DOI: 10.17116/hirurgia20171182-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- R N Komarov
- Clinic of Aortic and Cardiovascular Surgery of Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - S V Chernyavskiy
- Clinic of Aortic and Cardiovascular Surgery of Sechenov First Moscow State Medical University, Moscow, Russia
| | - P P Kim
- Moscow Clinical Research Center, Moscow, Russia
| | - A G Yavorovskiy
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
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Senarslan O, Kantarci UH, Eyuboglu M, Senarslan DA. Is it possible? Invasion of the heart with hepatocellular carcinoma in a short time. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Smillie RP, Shetty M, Boyer AC, Madrazo B, Jafri SZ. Imaging evaluation of the inferior vena cava. Radiographics 2016; 35:578-92. [PMID: 25763740 DOI: 10.1148/rg.352140136] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The inferior vena cava (IVC) is an essential but often overlooked structure at abdominal imaging. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for referring clinicians. Initial evaluation of the IVC is most likely to occur at computed tomography performed for another indication. Many routine abdominal imaging protocols may result in suboptimal evaluation of the IVC; however, techniques to assist in specific evaluation of the IVC can be used. In this article, the authors review the spectrum of IVC variants and pathologic processes and the relevant findings from magnetic resonance imaging, angiography, sonography, and positron emission tomography. Embryologic development of the IVC and examples of congenital IVC variants, such as absence, duplication, left-sided location, azygous or hemiazygous continuation, and web formation, are described. The authors detail IVC involvement in Wilms tumor, leiomyosarcoma, adrenal cortical carcinoma, testicular carcinoma, hepatocellular carcinoma, renal cell carcinoma, and other neoplasms, as well as postsurgical, traumatic, and infectious entities (including filter malposition, mesocaval shunt, and septic thrombophlebitis). The implications of these entities for patient treatment and instances in which specific details should be included in the dictated radiology report are highlighted. Furthermore, the common pitfalls of IVC imaging are discussed. The information provided in this review will allow radiologists to detect and accurately characterize IVC abnormalities to guide clinical decision making and improve patient care.
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Affiliation(s)
- Richard P Smillie
- From the Department of Diagnostic Radiology, Beaumont Health System, Beaumont Hospital Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI 48073 (R.P.S., M.S., A.C.B., S.Z.J.); and Department of Medicine, University of Miami Health System, University of Miami Hospital, Miami, Fla (B.M.)
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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: 2.2] [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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Kurahashi S, Sano T, Natsume S, Senda Y, Yamaura H, Inaba Y, Shimizu Y. Surgical treatment after hepatic arterial infusion chemotherapy for hepatocellular carcinoma extending into the right atrium. Surg Case Rep 2015; 1:47. [PMID: 26366344 PMCID: PMC4560137 DOI: 10.1186/s40792-015-0047-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023] Open
Abstract
A resected case of hepatocellular carcinoma which extended into the right atrium after treatment with hepatic arterial infusion chemotherapy (HAIC) is described. An 81-year-old man presented with right hypochondralgia. CT demonstrated a hypervascular tumor 11.5 cm in diameter extending into the right atrium through the right hepatic vein. The patient underwent HAIC with 100 mg of cisplatin (CDDP IA-call®) particles three times every month. The tumor showed a marked shrinkage and an involution of the venous thrombus around the orifice of the right hepatic vein. Right hemihepatectomy with tumor thrombectomy was performed as a salvage surgery using a total hepatic vascular exclusion technique. Histologically, the tumor turned into diffuse necrosis and fibrosis, so viable tumor cells were encountered neither in the main tumor nor venous thrombus. The therapeutic effect of HAIC was pathological complete remission. The patient has been doing well for 6 years after the surgery without evidence of tumor recurrence. The salvage operation was safely achievable for the initially unresectable advanced hepatocellular carcinoma extending into the right atrium.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi Japan
| | - Seiji Natsume
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yoshiki Senda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Hidekazu Yamaura
- Department of Interventional Radiology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yoshitaka Inaba
- Department of Interventional Radiology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi Japan
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Albackr HB. A large Right atrial mass in a patient with hepatocellular carcinoma: Case report and literature review. J Saudi Heart Assoc 2014; 26:174-8. [PMID: 24954992 PMCID: PMC4062757 DOI: 10.1016/j.jsha.2014.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a common malignancy and the most frequent sites of metastasis include lungs, bone, lymphatic, and brain, however, Intra-cardiac involvement rarely develops in patients with HCC and it has poor prognosis. The clinical course may be complicated by many fatal cardiovascular complications. Absence of cardiac symptoms, however, is an unusual condition. CASE REPORT We reported a rare case of hepatocellular carcinoma with large invasion into the right atrium and no cardiac symptoms. CONCLUSION Cardiac metastases occur in 10% of all cancer patients. Heart involvement should be suspected in all patients.
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Affiliation(s)
- Hanan B. Albackr
- King Fahad Cardiac Center, King Khalid University Hospital College of Medicine, King Saud University
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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: 1.0] [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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Li AJ, Yuan H, Yin L, Che Q, Lang XL, Wu MC. Cavoatrial thrombectomy in hepatocellular carcinoma with tumor thrombus in the vena cava and atrium without the use of cardiopulmonary bypass. Ann Vasc Surg 2014; 28:1565.e5-8. [PMID: 24561210 DOI: 10.1016/j.avsg.2014.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/08/2014] [Accepted: 02/09/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in hepatic vein, inferior vena cava (IVC), and right atrium (RA) portends a poor prognosis because of intravascular extension leading to rapid distal metastases. En bloc resection of cavoatrial TT without the use of cardiopulmonary bypass (CPB) is challenging. We describe a new method of vascular occlusion for thrombus entering into the RA without the need for CPB as shown in echocardiography. METHODS AND RESULTS Retrospective analysis was carried out in 1 HCC patient, who had undergone hepatectomy with TT extension into IVC and RA. The infrahepatic IVC was occluded with vascular tape and the right atrial appendage was controlled with a Satinsky clamp proximal to the TT. The IVC wall was incised under direct vision from the infrahepatic IVC cranially. The tumor and thrombus were then removed en bloc under direct vision. Thus, cavoatrial thrombectomy was performed under total hepatic vascular exclusion without the use of CPB. He survived for 6 months and died of tumor recurrence. CONCLUSIONS Using this technique, advanced HCC with cavoatrial TT can be resected safely without CPB and thereby avoid dislodgement of TT and air embolism.
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Affiliation(s)
- Ai-Jun Li
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
| | - Hang Yuan
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Lei Yin
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Qiang Che
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Xi-Long Lang
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China
| | - Meng-Chao Wu
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China
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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: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Hideki Yokoo
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Yosuke Tsuruga
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Kazuaki Nakanishi
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Tsuyoshi Shimamura
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Satoru Todo
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan
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Siddiqui MU, Khan M, Anderson T. Right Atrial Mass in a Patient With HIV and Hepatitis B: A Case Report. Cardiol Res 2013; 4:165-167. [PMID: 28352440 PMCID: PMC5358202 DOI: 10.4021/cr293w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/03/2022] Open
Abstract
A 41-year-old man presented to the emergency room for evaluation of substernal chest pain, shortness of breath and generalized failure to thrive. Patient had history of hepatitis B and HIV. During recent evaluation of hepatic mass, patient was found to have hepatocellular carcinoma on biopsy. Patient had no history of cirrhosis of the liver in the past. On Echocardiogram patient was noted to have a large mass filling the right atrial cavity. CT scan of abdomen, pelvis and chest showed a diffusely enlarged heterogeneously enhancing liver consistent with large hepatoma, with portal venous and hepatic vein thrombosis. Tumor thrombus extended through the hepatic veins and upper inferior vena cava into the right atrium. There was 6 cm greatest diameter enhancing mass in the right atrium. Patient had primary hepatocellular carcinoma with extensive invasion into vascular structures. His prognosis was poor and patient opted for palliative care only. In conclusion, patients with co-infection of HIV and Hepatitis B are at risk of developing hepatocellular carcinoma with extension into the right atrium and physicians managing these patients should have high suspicion of right atrial involvement with tumor extension and low threshold to order a screening echocardiogram.
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Affiliation(s)
- Muhammad Umer Siddiqui
- Internal Medicine, Mount Sinai Hospital-Englewood program, 151 engle st Apt A11 englewood NJ 07631, USA
| | - Masroor Khan
- Interventional Cardiology, 10021 S Main St suite B-1 Houston TX 77025, USA
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Duan CH, Tai S. Progress in treatment of hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis. Shijie Huaren Xiaohua Zazhi 2013; 21:2294-2299. [DOI: 10.11569/wcjd.v21.i23.2294] [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] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) with compressed inferior vena cava (IVC) or IVC tumor thrombosis (IVCTT) is an advanced-stage disease that has traditionally been considered a relative contraindication for surgical management and therefore has an extremely poor prognosis. Non-surgical treatment for these patients can lead to tumor invasion to the right atrium, which can cause heart failure and sudden death. In recent years, the development of innovative surgical techniques has made a curative surgical approach to tumors involving both the liver and IVC possible. The purpose of this article is to review the progress in treatment of HCC with IVC invasion and/or thrombosis.
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Advanced hepatocellular carcinoma with subtotal occlusion of the inferior vena cava and a right atrial mass. Case Rep Vasc Med 2013; 2013:489373. [PMID: 23662245 PMCID: PMC3639686 DOI: 10.1155/2013/489373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/14/2013] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.
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Kawakami M, Koda M, Mandai M, Hosho K, Murawaki Y, Oda W, Hayashi K. Isolated metastases of hepatocellular carcinoma in the right atrium: Case report and review of the literature. Oncol Lett 2013; 5:1505-1508. [PMID: 23760591 PMCID: PMC3678705 DOI: 10.3892/ol.2013.1240] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/21/2013] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to clarify the clinical features of patients with isolated HCC metastases to the heart. A 66-year-old female hospitalized with a hepatocellular carcinoma (HCC) ranging from the right to the left lobe and with a tumor thrombus in the main portal vein, was treated with intraarterial cisplatin, 5-fluouracil, adriamycin and mitomycin. Computed tomography (CT) one month later revealed that the HCC had progressed with multiple lung metastases and moderate ascites. The patient had no symptoms. Magnetic resonance imaging (MRI) and echocardiography revealed a round, movable tumor with a diameter of 2 cm in the right atrium (RA). The patient succumbed to HCC five months later. An autopsy revealed HCC with portal tumor thrombi and metastases to the lungs, inferior vena cava (IVC) and RA. The metastases in the RA and IVC were not continous with the intrahepatic tumor and were histologically attached to the endocardium and endothelium, respectively. An isolated metastasis of a HCC of the RA and IVC is extremely rare. In conclusion, although the majority of isolated metastases of HCC to the heart were diagnosed by echocardiography and were treated with mainly surgery, they had poor prognosis. The echocardiography should be performed for patients with advanced HCC. A novel treatment including molecular targeted drugs is required.
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Affiliation(s)
- Manri Kawakami
- Department of Multidisciplinary Internal Medicine, Division of Medicine and Clinical Science, School of Medicine, Yonago 683-8504, Japan
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Vallakati A, Chandra PA, Frankel R, Shani J. Intra-atrial tumor thrombi secondary to hepatocellular carcinoma responding to chemotherapy. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:435-7. [PMID: 22362455 PMCID: PMC3271401 DOI: 10.4297/najms.2011.3435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context: Hepatocellular carcinoma accounts for 1-2.5% of all cancer in America with extension to inferior vena cava and right atrium in 1-4% of the cases. Patients with advanced hepatocellular carcinoma invading the right heart are considered poor candidates for surgery. In the past, such patients had dismal prognosis due to complications like pulmonary embolism and sudden death. Case Report: Our patient was admitted with worsening jaundice, abdominal pain and significant weight loss. Abdominal ultrasound, elevated alfa feto-protein levels and computerized tomography pointed to the diagnosis of hepatocellular carcinoma. Transthoracic echocardiography demonstrated two masses in the right atrium with the base of masses extending from inferior vena cava into right atrium. The patient was diagnosed to have stage IV heptaocellular carcinoma. This is associated with dismal prognosis. But after being started on sorafenib, the tumor regressed considerably and was barely discernable on echocardiography performed a month later. Conclusion: Though aggressive surgical resection is the best therapeutic approach for hepatocellular carcinoma, it may not always be possible and in such cases combination of different therapeutic approaches such as chemotherapeutic agents, radiotherapy and chemoembolization may improve survival.
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Affiliation(s)
- Ajay Vallakati
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Wang Y, Yuan L, Ge RL, Sun Y, Wei G. Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol 2012; 20:914-22. [PMID: 22956071 DOI: 10.1245/s10434-012-2646-2] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The significance of surgery in the treatment of hepatocellular carcinoma (HCC) extending into the inferior vena cava (IVC)/right atrium (RA) is currently unclear. We sought to clarify whether surgical treatment can improve survival in such patients. METHODS A retrospective review was undertaken of patients with HCC and IVC/RA tumor thrombus who were potential candidates for surgery but who were finally treated surgically and nonsurgically between September 2000 and October 2010. The patients were subdivided according to therapeutic modalities, and the results for each group were compared. RESULTS A total of 56 patients were included in this study. They were divided into three groups. Twenty-five patients underwent hepatectomy plus thrombectomy (surgical group), with minor morbidity and no mortality; the patients in this group had 1-, 3-, and 5-year survival rates of 68.0, 22.5, and 13.5%, respectively, with a median survival of 19 months. Twenty patients were treated with transcatheter arterial chemoembolization, with 1- and 3-year survival rates of 15.0 and 5.0%, respectively (median survival 4.5 months). Eleven patients received symptomatic treatment only, and no one in this group survived longer than 1 year (median survival 5 months). The patients in surgical group survived significantly longer than the patients in the other two groups (p < 0.001). CONCLUSIONS Although technically challenging, surgery for HCC with IVC/RA tumor thrombus can be safely performed and should be considered in patients with resectable primary tumor and sufficient hepatic reservoir because compared with transcatheter arterial chemoembolization or symptomatic treatment, it significantly improved patient survival.
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Affiliation(s)
- Yi Wang
- The Second Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
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Hepatocellular carcinoma with intracardiac extension. Clin Gastroenterol Hepatol 2012; 10:e4. [PMID: 21893126 DOI: 10.1016/j.cgh.2011.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/27/2011] [Indexed: 02/07/2023]
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Inoue Y, Hayashi M, Katsumata T, Shibayama Y, Tanigawa N. Hepatocellular carcinoma with right atrial tumor thrombus: report of a case. Surg Today 2011; 41:1122-9. [PMID: 21773904 DOI: 10.1007/s00595-010-4443-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/12/2010] [Indexed: 12/14/2022]
Abstract
Hepatocellular carcinoma (HCC) with a tumor thrombus (TT) extending into the right atrium is generally regarded as a terminal-stage condition. We report a case of long-term survival following treatment of this complication with en bloc hepatectomy and resection of the thrombus under cardiopulmonary bypass. Our review of 19 similar cases reported in the literature found the following: that lung metastasis, the most critical prognostic factor, occurred in only 5 (27.8%) patients; that postoperative survival ranged from 18 days to 56 months, with a median survival of 11 months; and that 7 (38.9%) patients showed no signs of recurrence, with 4 (21.1%) surviving longer than 2 years. Thus, to prevent sudden death and extend the survival of patients with HCC and TT extending into the right atrium, we advocate simultaneous en bloc resection performed under cardiopulmonary bypass, provided distant metastasis and recurrence in the remnant liver are controlled.
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Affiliation(s)
- Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Koçak E, Tuna Y, Ertugrul I, Arhan M, Köklü S. Metastasis of hepatocellular carcinoma into the right atrium. Clin J Oncol Nurs 2011; 15:243-4. [PMID: 21624858 DOI: 10.1188/11.cjon.243-244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fujihara H, Chikazu D, Saijo H, Suenaga H, Mori Y, Iino M, Hamada Y, Takato T. Metastasis of hepatocellular carcinoma into the mandible with radiographic findings mimicking a radicular cyst: a case report. J Endod 2010; 36:1593-6. [PMID: 20728734 DOI: 10.1016/j.joen.2010.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/07/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a common neoplasm worldwide, with more than half of the tumors associated with regional metastasis. Extrahepatic metastasis is also common, and the most frequently affected sites are the lungs, abdominal lymph nodes, diaphragm, and bone. However, HCC metastasis to the mandible is rare, with approximately 50 cases reported in the literature. METHODS In this report, we describe a case of HCC metastasis to the mandible at the apex of #18 root in a 62-year-old man. This patient had already been diagnosed with metastasis to pancreatic caput lymph node. The radiographic features of the mandible resembled radicular cyst and did not show typical findings of malignancy. RESULTS Under the first diagnosis of radicular cyst, root canal treatment was initially performed, and then surgical treatment of the removal of the cystic lesion and #18 extraction were performed. Finally, the lesion was diagnosed as HCC metastasis from pathological examination. Consequently, he received constitutional chemotherapy in the hepatitis unit and is now in remission. CONCLUSION This case shows the importance of considering the differential diagnosis of malignancy.
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Affiliation(s)
- Hisako Fujihara
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Kanagawa, Japan.
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Liu YC, Ho YL, Huang GT, Chen DS, Sheu JC, Chen CH. Clinical manifestations and survival of patients with hepatocellular carcinoma and cardiac metastasis. J Gastroenterol Hepatol 2010; 25:150-5. [PMID: 19929928 DOI: 10.1111/j.1440-1746.2009.06036.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Antemortem diagnosis of hepatocellular carcinoma (HCC) with cardiac metastasis is uncommon. To clarify the clinical manifestation and survival of HCC patients with cardiac metastases, we initiated the present study. METHODS We retrospectively analyzed 48 HCC patients with metastases into cardiac cavity diagnosed antemortem. The baseline clinical characteristics, echocardiogram, treatment modality and the outcome data were collected. RESULTS The most common symptoms of cardiac metastasis included asymptomatic in 19 cases (39.5%), bilateral lower leg edema in 18 cases (37.5%) and exertional dyspnea in 15 cases (31.3%). The median and mean survival times from the time of diagnosis of cardiac metastasis were 102 days and 161 days, respectively. Compared with another cohort of 48 patients with age-, gender-, and stage-matched HCC patients without cardiac metastasis, the median survival in the cardiac metastasis group was similar to the control group (68 days) (P = 0.67). The cause of death was HCC in 29, hepatic failure in seven, multiple organ failure in four, gastrointestinal bleeding in three, sepsis in two, pulmonary embolism in one, respiratory failure in one, and acute myocardial infarction in one. CONCLUSIONS Hepatocellular carcinoma patients with cardiac metastases were in the advanced stages. These patients had limited survival from the diagnosis of cardiac metastases. The most common cause of death was related to HCC per se or the underlying liver disease. Only a few patients expired because of cardiac metastases.
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Affiliation(s)
- Yu-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Florman S, Weaver M, Primeaux P, Killackey M, Sierra R, Gomez S, Haque S, Regenstein F, Balart L. Aggressive Resection of Hepatocellular Carcinoma with Right Atrial Involvement. Am Surg 2009. [DOI: 10.1177/000313480907501116] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatocellular carcinoma with extension into the right heart is a recognized, albeit rare occurrence. Patients who present with tumors extending into the heart have generally been considered inoperable and had limited survival, many sustaining tumor embolism and/or sudden death. Resection has been fraught with intraoperative and perioperative mortality as well as considerable postoperative morbidity. We report an exceptional case of a patient with such a tumor successfully treated with an aggressive surgical approach and review the limited published experience.
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Affiliation(s)
- Sander Florman
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Michael Weaver
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Paul Primeaux
- Department of Anesthesia, Tulane University, New Orleans, Louisiana
| | - Mary Killackey
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Rafael Sierra
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Santiago Gomez
- Department of Anesthesia, Tulane University, New Orleans, Louisiana
| | - Salima Haque
- Department of Pathology, Tulane University, New Orleans, Louisiana
| | | | - Luis Balart
- Department of Medicine, Tulane University, New Orleans, Louisiana
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Hepatocellular carcinoma with intracavitary cardiac involvement: a case report and review of the literature. Am J Cardiol 2008; 102:643-5. [PMID: 18721529 DOI: 10.1016/j.amjcard.2008.04.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/17/2008] [Accepted: 04/17/2008] [Indexed: 12/25/2022]
Abstract
A 71-year-old man with hepatocellular carcinoma (HCC) presented with intracavitary cardiac involvement detected incidentally on surveillance computed tomography. Tumor with associated thrombus was found to extend from the liver through the inferior vena cava into the right atrium. This intracardiac mass prolapsed intermittently into the right ventricle, causing functional tricuspid stenosis. The mass was resected but recurred after 4 months, eventually causing refractory right-sided heart failure. This case illustrates how intracavitary cardiac involvement of HCC can develop insidiously and confer significant hemodynamic compromise. A review of the published research, including postmortem studies, demonstrates that the frequency of intracardiac mass lesions in HCC is not insignificant. In conclusion, early detection and diagnosis may have increasing importance in the advent of new therapies for treating advanced HCC.
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