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Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

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Related in: MedlinePlus

Gadoxetic acid-enhanced liver MRI before TARE. The image reveals a 2.7 cm sized arterial enhanced nodule (arrow) in segment 4 with delayed washout (A, B, C). Another nodule (arrowhead) measuring 0.6 cm was noted in segment 7 (D, E, F). (A, D) Arterial phase. (B, E) E Portal venous phase. (C, F) Hepatobiliary phase.
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Figure 1: Gadoxetic acid-enhanced liver MRI before TARE. The image reveals a 2.7 cm sized arterial enhanced nodule (arrow) in segment 4 with delayed washout (A, B, C). Another nodule (arrowhead) measuring 0.6 cm was noted in segment 7 (D, E, F). (A, D) Arterial phase. (B, E) E Portal venous phase. (C, F) Hepatobiliary phase.

Mentions: A 67-year-old male, inactive hepatitis B virus (HBV) carrier (HBeAg negative with undetectable serum HBV DNA level), was admitted for further evaluation and treatment of hepatic masses. He had a relatively good performance status (grade 1). Laboratory tests showed serum albumin level of 3.7 g/dL, bilirubin level of 1.5 mg/dL, and prothrombin time international normalized ratio of 1.40. Neither ascites nor hepatic encephalopathy was found, which was compatible with Child-Pugh class A. Serologic marker for hepatitis C was negative. Serum alpha-fetoprotein level was increased to 1,298 ng/mL. Dynamic enhanced computed tomography (CT) revealed underlying liver cirrhosis with a hepatic mass measuring 2.7 cm in segment 4 and another lesion measuring 0.6 cm in segment 7 with typical patterns of arterial enhancement and delayed washout. Gadoxetic acid-enhanced liver magnetic resonance imaging showed slightly high signal intensity in the T2 and diffusion-weighted image with a defect in 20-minute delayed image for these two lesions (Fig. 1). These findings were compatible with HCC (T3N0M0), stage III.


Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Gadoxetic acid-enhanced liver MRI before TARE. The image reveals a 2.7 cm sized arterial enhanced nodule (arrow) in segment 4 with delayed washout (A, B, C). Another nodule (arrowhead) measuring 0.6 cm was noted in segment 7 (D, E, F). (A, D) Arterial phase. (B, E) E Portal venous phase. (C, F) Hepatobiliary phase.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197179&req=5

Figure 1: Gadoxetic acid-enhanced liver MRI before TARE. The image reveals a 2.7 cm sized arterial enhanced nodule (arrow) in segment 4 with delayed washout (A, B, C). Another nodule (arrowhead) measuring 0.6 cm was noted in segment 7 (D, E, F). (A, D) Arterial phase. (B, E) E Portal venous phase. (C, F) Hepatobiliary phase.
Mentions: A 67-year-old male, inactive hepatitis B virus (HBV) carrier (HBeAg negative with undetectable serum HBV DNA level), was admitted for further evaluation and treatment of hepatic masses. He had a relatively good performance status (grade 1). Laboratory tests showed serum albumin level of 3.7 g/dL, bilirubin level of 1.5 mg/dL, and prothrombin time international normalized ratio of 1.40. Neither ascites nor hepatic encephalopathy was found, which was compatible with Child-Pugh class A. Serologic marker for hepatitis C was negative. Serum alpha-fetoprotein level was increased to 1,298 ng/mL. Dynamic enhanced computed tomography (CT) revealed underlying liver cirrhosis with a hepatic mass measuring 2.7 cm in segment 4 and another lesion measuring 0.6 cm in segment 7 with typical patterns of arterial enhancement and delayed washout. Gadoxetic acid-enhanced liver magnetic resonance imaging showed slightly high signal intensity in the T2 and diffusion-weighted image with a defect in 20-minute delayed image for these two lesions (Fig. 1). These findings were compatible with HCC (T3N0M0), stage III.

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

Show MeSH
Related in: MedlinePlus