A successful case of more than 5 years of disease free survival in hepatocellular carcinoma with tumor thrombus to the right main branch of portal vein after repeated hepatic resection following transhepatic arterial embolization (TAE)

A case is a male in his 50's. He received hepatic resections twice for hepatocellular carcinoma. Recurrence was pointed out in the residual liver with tumor thrombus to the right branch of the portal vein. The serum level of AFP was 648 ng/ml. We performed transhepatic arterial embolization (TAE) with Epi-ADM, CDDP, Lipiodol and spongel through the right hepatic artery before re-hepatectomy. Posterior segmentectomy with an extraction of portal vein thrombus was performed. Pathological findings showed complete necrosis not only in the main tumor but in the portal vein thrombus also. He is alive for more than 5 years without recurrence after surgeries following pre-operative TAE.     

肝癌门静脉癌栓多排螺旋CT三维成像

目的 探讨门静脉癌栓多排螺旋CT3D成像的临床意义。方法 收集了57例门静脉3D成像,6例正常,5例肝硬化门脉高压,42例肝癌门静脉癌栓,4例肝门部淋巴结肿大患者,所有病例来源于肝脏常规双期扫描。对比剂按1.5-2ml/kg,对比剂注射流率2.5-3ml/s,门脉期延迟时间60-70s。对肝癌形成的42例门静脉癌栓进行轴位和3D成像观察,并行两组对照。结果 根据癌栓不同部位分为门脉左支(13例)、右支(20例)、主干(9例)3种类型。3D成像与轴位之间对显示门静脉癌栓没有差异性(P>0.05),但3D对显示主干栓塞形成的侧支循环优于轴位。结论 门静脉癌栓多排螺旋CT3D成像可较好地多方位显示癌栓部位及癌栓类型,CT3D成像和轴位结合可更好地对门静脉癌栓作出判断,以进一步指导临床对治疗方案的选择。     

Successful treatment for advanced cholangiocellular carcinoma with intrahepatic metastasis and/or portal vein tumor thrombi by intraarterial chemotherapy combined with 5-fluorouracil, adriamycin and cisplatin (FAP)--two cases report

The patients of unresectable cholangiocellular carcinoma (CCC) have extremely poor prognosis. Case 1 was a 72-year-old male who had CCC in the left lobe of liver with intrahepatic metastasis. From June 2003, he received hepatic arterial infusion chemotherapy (FAP: 5-fluorouracil 250 mg/day continuous infusion, day 1-5, adriamycin 10 mg/day, day 1, and CDDP 10 mg/day, day 1). After 5 courses, abdominal CT revealed that the main tumor had regressed. Case 2 was a 66-year-old male who had CCC with portal vein tumor thrombus of anterior branch (Vp2). He received FAP arterial infusion chemotherapy that was a same regimen as with the case 1 patient. After 5 courses were administered, Abdominal CT revealed that the size of the main tumor at S8 had not changed, and that portal vein tumor thrombus had disappeared. In both cases, there was no complication related to the chemotherapy. They are alive for more than 1 year after chemotherapy had started. FAP hepatic arterial infusion chemotherapy might be promising as an effective therapy for non-resectable CCC without extra hepatic metastasis.     

A complete response to one-shot hepatic arterial infusion of epirubicin in a patient with highly advanced hepatocellular carcinoma

A 61-year-old male was admitted for advanced hepatocellular carcinoma (HCC) with multiple lung metastases and tumor thrombus in the portal vein and superior vena cava. At first, we planned to perform transcatheter arterial embolization (TAE) to avoid the rupture of the liver tumor. But, due to the severe liver dysfunction, ie Child-Pugh C and 36% ICG R15, hepatic arterial infusion (HAI) of epirubicin 40 mg was performed. After that, the patient was followed at the outpatient ward and his general condition has gradually improved without a special treatment. At the present, one year and ten month after HAI, the serum alpha-fetoprotein (AFP) is almost within normal limits and CT scans show that HCC with multiple lung metastases, and tumor thrombus in the portal vein and superior vena cava almost disappeared. Although, spontaneous regression of HCC was a rare phenomenon, it might have played a major role in the good anticancer efficacy of this patient as well as high anti-cancer agent sensitivity of his liver tumor.     

A successful case of hepatocellular carcinoma with portal venous tumor thrombus (Vp2) treated by transcatheter arterial chemoembolization

We reported a case of hepatocellular carcinoma (HCC) with portal venous tumor thrombus (PVTT) (Vp2) successfully treated by transcatheter arterial chemoembolization (TACE), and the tumor showed complete response and the patient survived for 28 months. A 67-year-old male was diagnosed with HCC in the area of subsegment 5 with PVTT from the P5 to the posterior branch. He was treated by segmental TACE. The tumor markers decreased within normal limits, and localized hepatic infraction in the subsegment 5 and atrophy of the PVTT were recognized. He survived for 28 months with no tumor recurrence after the first TACE. This case suggested that embolization might play a part of treatment to HCC with PVTT, if the liver function was preserved and the lesion of liver infraction was limited.     

A case report of hepatocellular carcinoma with hepatic and portal venous tumor thrombus and multiple intrahepatic metastasis who survived over 1 year after the operation with combined locoregional chemotherapy

Hepatocellular carcinoma (HCC) with vascular invasion and/or intrahepatic metastasis (IM) has a poor prognosis, so advanced HCC may be considered as a contraindication for hepatectomy. We experienced a case of HCC with hepatic venous and portal venous tumor thrombus and multiple IM who survived over 1 year after the operation with combined locoregional chemotherapy. (Case): A 67-year-old male patient was diagnosed with HCC with extracapsular invasion after transarterial embolization (TAE). CT scan revealed the HCC had a right portal venous tumor thrombus and multiple IM. Posterior lobectomy and thrombectomy of hepatic venous and portal venous tumor thrombus and placement of portal venous catheter ware performed. From the first day after operation the patient received continuous intravenous and intraportal 5-FU for 3 weeks. At the first month after operation, TAE and PEIT were given against residual IM. After discharge the patient received hepatic arterial infusion chemotherapy (MTX/CDDP/5-FU/Leucovorin). Fourteen months after operation, the patient is surviving in good physical condition.     

A long-term survival case of unresectable hepatohilar bile duct cancer treated with radiotherapy and hepatic arterial infusion chemotherapy

The patient, a 79-year-old woman, underwent distal gastrectomy for gastric cancer in November 2002. The lesion was judged to be T1 N0H0POM0 and fStage IA. A hepatohilar tumor was found 1 year after gastrectomy by CT scan. Radiological examinations revealed a presence of right portal vein stenosis and left portal vein obstruction due to hepatohilar bile duct cancer. Surgical treatment was considered to be difficult because of the consequence of the tumor involved in the right hepatic artery. We performed hepatic arterial infusion chemotherapy of 5-fluorouracil 1000 mg/body/week for 8 courses through the reservoir catheter. Radiation therapy was delivered concurrently with hepatic arterial infusion. The condition of the patient was good after receiving 40 Gy, Three months after the additional 20 Gy radiation, the tumor was markedly reduced in size, and was not detected 7 months thereafter. MRI showed no recurrence for three and a half years since chemo-radiation.     

Comparison of percutaneous microwave coagulation area under interruption of hepatic arterial blood flow with that under hepatic arterial and venous blood flow for hepatocellular carcinoma

The study subjects were 49 patients with hepatocellular carcinoma. Twenty-nine patients underwent hepatic arterial blood flow block via thrombosis of the cancer-bearing area with a gelatin sponge, while the other 20 patients underwent a combination of hepatic arterial block and partial blood flow block of the portal vein with a hepatic venous balloon. Percutaneous microwave coagulation therapy (PMCT) was performed on these patients according to the type of hepatic blood flow block, and the diameters of the coagulation areas in the two groups were compared using CT images taken under portal venography. The 29 patients who underwent hepatic arterial block (A-PMCT) had a mean tumor diameter of 19.2 +/- 8 mm, while the 20 patients who underwent hepatic arterial and hepatic venous block (AV-PMCT) had a mean tumor diameter of 25.3 +/- 8.3 mm. PMCT was performed at 60 W. The mean coagulation time and the mean coagulation diameter were 4.2 +/- 1.1 min and 36.3 +/- 12.3 mm, respectively, for the A-PMCT group and 5.5 +/- 1.8 min and 43.9 +/- 9.8 mm, respectively, for the AV-PMCT group. A comparison of the coagulation diameters indicated that the AV-PMCT group had a significantly greater coagulation area than the A-PMCT group (p < 0.05).     

胃癌合并门静脉癌栓的CT表现

为了提高对胃癌合并门静脉癌栓CT表现的认识,回顾性分析1990年5月23日~2005年9月18日7例经胃镜、手术病理及临床确诊的胃癌合并门静脉癌栓患者的资料。7例患者均行CT平扫加增强检查。CT检查均显示胃病变区胃壁明显不规则增厚,3例患者出现肝转移灶。门脉癌栓栓子发生的部位主要位于门脉主干段(7例),其中2例累及左、右分支;1例累及肠系膜上静脉;1例同时累及肠系膜上静脉和脾静脉。7例患者中有5例癌栓未见明显强化,2例患者增强后癌栓轻度强化。5例患者癌栓的所在门脉主干明显扩张,门脉血流阻断,5例患者扩张的门脉主干周围可见明显强化迂曲的侧枝血管影,其中2例出现大量腹水。研究结果显示,虽然绝大部分门静脉癌栓由原发性肝癌引起,但门静脉癌栓也可以是由进展期胃癌形成,密切结合临床资料,两者鉴别诊断并不困难。     

A case report of unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus responding to DSM-TACE (degradable starch microspheres-transcatheter arterial chemoembolization)

A 56-year-old man was revealed to be HCC with portal vein tumor thrombus. Curative operation was impossible because we recognized many daughter lesions in the liver. Tumor marker was very high. DSM-TACE was conducted as the first line therapy. There was no remarkable side effect. After two-course, the size of HCC was decreased in CT and tumor marker was normalized. Generally speaking, a prognosis of HCC with portal vein tumor thrombus is poor. Hence, DSM-TACE is one of the effective therapies for HCC with portal vein tumor thrombus.     

肝脏原发性平滑肌瘤影像学表现

Objective: To investigate the imaging features of primary hepatic leiomyoma. Methods: 3 patients of primary hepatic leiomyoma confirmed by pathology without immunodeficiency were retrospectively analyzed about CT and MRI findings, clinical and pathological correlation. 2 cases had routine CT scan, 2 cases had routine MRI. Results: 2 case CT scans showed low-density lesions, 2 cases MRI showed lesions with long T1 and long T2 signal. One case of uniform density and signal showed homogeneous enhancement; two cases showed uneven density and signal, of which one case was inhomogeneous enhancement. 3 cases presented pseudocapsule without hepatic cirrhosis and venous tumor thrombus. Pathology showed spindle tumor cell proliferation and capillary hyperplasia; one case showed central hyalinization and one case central liquefaction necrosis. Conclusion: Primary hepatic leiomyoma is a hypervascular tumor, and CT and MRI help in the diagnosis.     

A case of hepatocellular carcinoma with tumor thrombus in the right atrium successfully treated by arterial administration of lipiodol-SMANCS

In February, 1996, a 73-year-old male with liver dysfunction was admitted to our hospital for further examination and treatment of liver tumor. The liver tumor was revealed by imaging examination, which was mainly in the S4-S8 of liver with a thrombus growing from the right anterior branch to the right branch of the portal vein, and from the right hepatic vein to the inferior vena cava and right atrium. The serum AFP and PIVKA-II levels were elevated to 3.610 ng/ml and 54 AU/ml, respectively. The patient was diagnosed as having hepatocellular carcinoma, and was treated by arterial administration of anticancer drugs (epirubicin hydrochloride, mitomycin C and carboplatin) and TAE. Though the main tumor (S4-S8 of liver) was reduced by TAE, the portal and atrial tumor thrombus did not respond. One month after TAE (20 May, 1996), the first arterial administration of Lipiodol-SMANCS was given, followed by 4 successive procedures with an interval of about 1.5 months (total dose 15 mg), resulting in remarkable tumor thrombus shrinkage and reduction of AFP levels to 80 ng/ml. This case shows that arterial administration of SMANCS may be one of the effective treatments for hepatocellular carcinoma, even with tumor thrombus of hepatic vein, IVC and right atrium.     

超声造影评估原发性与转移性小肝癌的血流动力学比较研究

【摘 要】目的 探讨原发性和转移性小肝癌超声造影的血流动力学差异。方法 回顾性分析经病理及临床证实的210个原发性小肝癌和93个转移性小肝癌的超声造影表现,比较两组小肝癌在动脉期、门脉期和延迟期增强表现的异同。结果（1）303个小肝癌病灶,超声造影表现为动脉期快速增强、门脉期或延迟期消退,转移性小肝癌增强达峰时间和开始消退呈低回声时间明显早于原发性小肝癌（P＜0.05）。（2）超声造影动脉期显示,95.7％（201／210）的原发性和2.3％（2／93）的转移性小肝癌呈高回声（P＜0.05）,门脉期及延迟期显示原发性和转移性小肝癌的血流动力学变化差异无统计学意义（P＞0.05）。（3）在超声造影动脉期增强形态上,原发性小肝癌和转移性小肝癌分别有93.4％（196／210）和35.5％（33／93）的病灶呈整体均匀性增强（P＜0.05）;转移性小肝癌中,54.8％（51／93）的病灶周边呈环状或不规则状增强,明显高于原发性小肝癌的5.2％ （11／210）,差异有统计学意义（P＜0.05）。结论 转移性和原发性小肝癌在超声造影动脉期均呈快速增强,但在增强方式和开始消退呈低回声的时间上均存在一定差异。超声造影为原发性与转移性小肝癌的诊断与鉴别诊断提供了重要的影像学依据。     

肝脏淋巴瘤CT诊断及临床分析

目的 肝脏淋巴瘤临床罕见,既往容易误诊误治.本研究通过分析5例肝脏淋巴瘤的CT表现及临床特点,以期提高对其诊治水平.方法 回顾性分析2009-02-11-2016-04-30经3家医院(淄博市第一医院1例,上海市金山区中西医结合医院1例,复旦大学附属中山医院3例)诊治的5例病理及临床治疗证实的肝脏淋巴瘤患者的CT及临床资料.结果 5例中原发2例,继发3例.3例表现为肝内边界较清楚的结节和(或)肿块,最大直径34～107 mm,1例多发,2例单发;另外2例呈肝内边界模糊的多发斑片状“地图样”浸润.CT平扫病灶呈较均匀低或稍低密度,CT值为19.8～43.4 Hu.增强5例肿瘤动脉期均轻度强化,门脉期呈轻到中度持续强化,但弱于正常肝组织,平均CT值45.6～63.9 Hu,延迟期强化均减弱呈较低密度.4例肿瘤中见“血管漂浮征”;3例见腹腔、腹膜后肿大淋巴结,较均匀中度强化;临床3例出现低热及浅表淋巴结肿大;2例出现腹痛、腹胀及消瘦;1例扪及腹部包块;1例无特殊症状.5例均无明显肝硬化,4例出现肝功能异常,2例合并乙型肝炎.2例原发性者经外科手术治疗及内科治疗,3例继发性者经中西医结合内科综合治疗.4例经随访分别生存16～39个月,平均生存21个月,1例术后随访至7个月,未见复发转移.结论 肝脏淋巴瘤罕见而预后不佳,临床以低热、全身消耗症状、肝脏肿块及腹痛为主,CT可以显示病灶的一些病理学变化,对其诊断具有较大价值.     

肝癌的螺旋CT表现及鉴别诊断

目的　对 5 4例肝细胞性肝癌的螺旋CT双期扫描表现进行分析 ,探讨其在肝癌诊断及鉴别诊断中的价值。方法　对全部病例行全肝平扫和增强扫描。注射造影剂后 2 5s开始肝动脉期扫描 ,70s开始门脉期扫描。观察全部病灶在双期增强扫描中的表现。结果　肝动脉期扫描共发现病灶 72个 ,其中 2 8个病灶表现为均匀强化 ,40个为不均匀强化 (其中 4个还可见到供血动脉 ) ,另有 4个无明显强化。门脉期扫描中发现 6 2个病灶 ,均为低密度 ,其中 8例可见到门脉癌栓形成 ,另有 7个病灶可见到假包膜形成。结论　螺旋CT双期增强扫描可充分反映肝细胞性肝癌的特征 ,有利于诊断和鉴别诊断。     

多层螺旋CT血管成像在肝癌化疗栓塞中的临床指导作用

背景与目的：多层螺旋CT血管成像具有扫描速度快、覆盖范围大、肝脏血管图像清晰．多角度三维显示等特点,对肝脏病变的诊断和治疗已显示出重要价值。目前对于多层螺旋CT肝脏血管三维成像的研究主要集中在肝脏肿瘤、肝移植术前评价及肝脏血管系统解剖,对于指导肝癌动脉化疗栓塞的研究仍然有限。本研究通过对比分析肝癌患者肝脏多层螺旋CT血管成像（muhislice CT angiography,MSCTA）与数字减影血管造影（digital subtraction angiography,DSA）图像．探讨MSCTA在肝癌肝动脉化疗栓塞治疗中的临床指导作用。方法：本组50例肝癌患者行多层螺旋CT肝脏双期增强扫描。采用最大密度投影（maximal intensitypmjection,MIP）和容积再现（volume rendering technique,VRT）重建技术行肝动脉、门静脉血管成像,再经股动脉插管分别行腹腔动脉、肠系膜上动脉、肾动脉、膈动脉DSA造影及TACE治疗,对比分析肝癌MSCTA与DSA图像。结果：肝动脉解剖分型和肿瘤供血动脉来源的DSA与MSCT的MIP、VRT血管成像显示符合率达到100％,χ^2检验,两者间差异无统计学意义（P=1．00）,而对肝动门脉瘘及门脉癌栓的显示MSCTA比DSA更有优势。结论：MSCTA检查无创、简单易行,其图像的三维重建立体感强,可准确提供肝动脉、门静脉及肿瘤供血来源等信息,对指导肝癌经肝动脉化疗栓塞有很好的临床指导作用。     

Transcatheter arterial chemoembolization prolonged survival in a patient with advanced hepatocellular carcinoma accompanied by tumor thrombus of the portal vein trunk

A 50-year-old man having an advanced hepatocellular carcinoma (HCC) was admitted to our institution. An abdominal computed tomogram showed infiltrative mass in the right liver with tumor thrombus invading into the main trunk and contralateral branch of the portal vein. Repetitive transcatheter arterial chemoembolization reduced a tumor size and shrunken portal vein tumor thrombus. The tumor marker levels such as AFP and PIVKA-II decreased. During follow-up, he was diagnosed as having an impending rupture of HCC with acute abdominal pain. He was successfully treated with interventional technique. He died of liver failure 66 months after the first treatment. Although he had a highly advanced HCC with tumor thrombus of the portal vein, repetitive transcatheter arterial chemoembolization therapy may prolong survival.     

Temporary placement of inferior vena cava filter prior to transcatheter arterial embolization (TAE) for hepatocellular carcinoma with IVC tumor thrombus--prevention of pulmonary tumor emboli after TAE]

A 66-year-old-man with a right huge hepatocellular carcinoma (HCC) extending into both the right portal vein and the right atrium underwent transcatheter arterial embolization (TAE) via the right hepatic artery. Prior to the TAE, a temporary inferior vena cava (IVC) filter was placed suprarenally for prevention of pulmonary tumor emboli. When we replaced the temporary IVC filter with a new one 7 days after the TAE, the filter which was pulled out of the IVC captured a fragment of the tumor thrombus. A histopathological specimen demonstrated only ghost cells. The patient has been followed at our outpatient clinic without any tumor thrombus or pulmonary infarction for 13 months after this procedure.     

A case of intrahepatic cholangiocarcinoma successfully treated by hepatic arterial infusion chemotherapy

The patient was a 67-year-old man who had been operated for eshophageal cancer 4 years ago. He was diagnosed as intrahepatic cholangiocarcinoma by CT after 2 years of the operation. After admission to our hospital, he was treated by hepatic arterial infusion chemotherapy with CDDP, levofolinate calcium (L-LV) and 5-FU with chronomodulation. After a few more months of the treatment, abdominal CT revealed that the size of hepatic tumor decreased remarkably. There were no side effects without bone marrow suppression (grade 1). It seemed that hepatic arterial infusion chemotherapy with chronomodulation may be an effective strategy against intrahepatic cholangiocarcinoma in high risk case.     

无水酒精注射术治疗门静脉癌栓25例

目的:观察无水酒精注射术治疗中晚期原发性肝癌(PHC)合并门静脉癌栓的临床疗效。方法:25例合并门静脉癌栓的中晚期肝癌均在选择性肝动脉化疗栓塞(TACE)的基础上加门静脉癌栓内无水酒精注射术(PEI)。结果:穿刺准确度为100%,无严重并发症发生,总有效率76%。结论:TACE加PEI治疗中晚期PHC是一种有效的方法,效果优于单纯的TACE。