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Spontaneous complete necrosis of hepatocellular carcinoma: A case report and review of the literature.

Takeda Y, Wakui N, Asai Y, Dan N, Yamauchi Y, Ueki N, Otsuka T, Oba N, Nishinakagawa S, Minagawa M, Takeda Y, Shiono S, Kojima T - Oncol Lett (2015)

Bottom Line: In addition, occlusion due to thrombus was observed within the blood vessels passing inside the fibrous capsule.It was hypothesized that the formation of a thick fibrous capsule and occlusion due to thrombus in the feeding vessel were possibly involved as the cause of complete spontaneous necrosis.Written informed consent was obtained from the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan.

ABSTRACT

The present study reports the case of a 68-year-old male patient who presented to Tokyo Rosai Hospital for the treatment of alcoholic liver disease. A high density was observed in liver segment S2, while a tumor, 30 mm in size, exhibiting a low density was observed in the delayed phase upon contrast-enhanced computed tomography (CT), which was performed prior to admission. The tumor appeared slightly poorly defined upon abdominal ultrasound and was observed as a 30 mm low-echoic nodule that was internally heterogeneous. A 5-mm thick contrast enhancement effect was observed in the tumor border in the vascular phase on Sonazoid contrast-enhanced ultrasonography, while a defect in the entire tumor was observed in the post-vascular phase. Dysphagia had commenced three months prior to presentation and a weight loss of ~3 kg was observed. Therefore, the patient was admitted to Tokyo Rosai Hospital due to the presence of a hepatic tumor, and to undergo a close inspection of the cause of the tumor. Upon close inspection, it was determined that the weight loss and aphagia were caused by progressive bulbar paralysis. A contrast-enhanced CT was performed on post-admission day 29 as a follow-up regarding the hepatic tumor. As a result, although no change in the tumor size was observed, the contrast enhancement in the tumor borderline had disappeared. Necrosis of the tumor was considered. However, as viable persistence of the malignant tumor could not be excluded, a hepatic left lobe excision was performed. The patient was diagnosed with hepatocellular carcinoma (HCC) based on the morphology of the cellular necrosis. In addition, occlusion due to thrombus was observed within the blood vessels passing inside the fibrous capsule. It was hypothesized that the formation of a thick fibrous capsule and occlusion due to thrombus in the feeding vessel were possibly involved as the cause of complete spontaneous necrosis. Written informed consent was obtained from the patient.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced computed tomography performed on post-admission day 29. The tumor diameter was ~30 mm in size, and did not exhibit internal contrast enhancement. However, a thick membrane of ~5 mm was gradually imaged in the vicinity of the tumor (arrow), and a deeply-stained region with a 5 mm diameter, considered to be an arterio-portal shunt, was observed in the vicinity of this region (arrowhead). (a) Plain; (b) arterial phase; (c) portal phase; (d) delayed phase.
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f4-ol-09-04-1520: Contrast-enhanced computed tomography performed on post-admission day 29. The tumor diameter was ~30 mm in size, and did not exhibit internal contrast enhancement. However, a thick membrane of ~5 mm was gradually imaged in the vicinity of the tumor (arrow), and a deeply-stained region with a 5 mm diameter, considered to be an arterio-portal shunt, was observed in the vicinity of this region (arrowhead). (a) Plain; (b) arterial phase; (c) portal phase; (d) delayed phase.

Mentions: The AFP level increased slightly to 1.8 ng/ml and the PIVKA-II decreased by 41.0 mAU/ml, as observed on blood testing on post-admission day 23. An additional abdominal contrast-enhanced CT was performed on post-admission day 29, revealing no change in the tumor size, which remained at ~30 mm. However, the contrast enhancement of the tumor observed at the time of admission was no longer present, and a faint contrast enhancement that was 5 mm in width was instead observed surrounding the tumor. Additionally, a 5-mm wide deeply-stained region, hypothesized to be an arterio-portal (A-P) shunt was observed in the vicinity of the tumor (Fig. 4). The vascular and post-vascular phases of Sonazoid contrast-enhanced ultrasonography (Sonazoid perfluorobutane; GE Healthcare, Oslo, Norway), performed on post-admission day 30, revealed no enhancement in the tumor, but a defect ~30 mm in size was observed (Fig. 5). Necrosis of the tumor was suspected. However, as viable persistence of the malignant tumor could not be excluded, a hepatic left lobe excision was performed on post-admission day 43.


Spontaneous complete necrosis of hepatocellular carcinoma: A case report and review of the literature.

Takeda Y, Wakui N, Asai Y, Dan N, Yamauchi Y, Ueki N, Otsuka T, Oba N, Nishinakagawa S, Minagawa M, Takeda Y, Shiono S, Kojima T - Oncol Lett (2015)

Contrast-enhanced computed tomography performed on post-admission day 29. The tumor diameter was ~30 mm in size, and did not exhibit internal contrast enhancement. However, a thick membrane of ~5 mm was gradually imaged in the vicinity of the tumor (arrow), and a deeply-stained region with a 5 mm diameter, considered to be an arterio-portal shunt, was observed in the vicinity of this region (arrowhead). (a) Plain; (b) arterial phase; (c) portal phase; (d) delayed phase.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356411&req=5

f4-ol-09-04-1520: Contrast-enhanced computed tomography performed on post-admission day 29. The tumor diameter was ~30 mm in size, and did not exhibit internal contrast enhancement. However, a thick membrane of ~5 mm was gradually imaged in the vicinity of the tumor (arrow), and a deeply-stained region with a 5 mm diameter, considered to be an arterio-portal shunt, was observed in the vicinity of this region (arrowhead). (a) Plain; (b) arterial phase; (c) portal phase; (d) delayed phase.
Mentions: The AFP level increased slightly to 1.8 ng/ml and the PIVKA-II decreased by 41.0 mAU/ml, as observed on blood testing on post-admission day 23. An additional abdominal contrast-enhanced CT was performed on post-admission day 29, revealing no change in the tumor size, which remained at ~30 mm. However, the contrast enhancement of the tumor observed at the time of admission was no longer present, and a faint contrast enhancement that was 5 mm in width was instead observed surrounding the tumor. Additionally, a 5-mm wide deeply-stained region, hypothesized to be an arterio-portal (A-P) shunt was observed in the vicinity of the tumor (Fig. 4). The vascular and post-vascular phases of Sonazoid contrast-enhanced ultrasonography (Sonazoid perfluorobutane; GE Healthcare, Oslo, Norway), performed on post-admission day 30, revealed no enhancement in the tumor, but a defect ~30 mm in size was observed (Fig. 5). Necrosis of the tumor was suspected. However, as viable persistence of the malignant tumor could not be excluded, a hepatic left lobe excision was performed on post-admission day 43.

Bottom Line: In addition, occlusion due to thrombus was observed within the blood vessels passing inside the fibrous capsule.It was hypothesized that the formation of a thick fibrous capsule and occlusion due to thrombus in the feeding vessel were possibly involved as the cause of complete spontaneous necrosis.Written informed consent was obtained from the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan.

ABSTRACT

The present study reports the case of a 68-year-old male patient who presented to Tokyo Rosai Hospital for the treatment of alcoholic liver disease. A high density was observed in liver segment S2, while a tumor, 30 mm in size, exhibiting a low density was observed in the delayed phase upon contrast-enhanced computed tomography (CT), which was performed prior to admission. The tumor appeared slightly poorly defined upon abdominal ultrasound and was observed as a 30 mm low-echoic nodule that was internally heterogeneous. A 5-mm thick contrast enhancement effect was observed in the tumor border in the vascular phase on Sonazoid contrast-enhanced ultrasonography, while a defect in the entire tumor was observed in the post-vascular phase. Dysphagia had commenced three months prior to presentation and a weight loss of ~3 kg was observed. Therefore, the patient was admitted to Tokyo Rosai Hospital due to the presence of a hepatic tumor, and to undergo a close inspection of the cause of the tumor. Upon close inspection, it was determined that the weight loss and aphagia were caused by progressive bulbar paralysis. A contrast-enhanced CT was performed on post-admission day 29 as a follow-up regarding the hepatic tumor. As a result, although no change in the tumor size was observed, the contrast enhancement in the tumor borderline had disappeared. Necrosis of the tumor was considered. However, as viable persistence of the malignant tumor could not be excluded, a hepatic left lobe excision was performed. The patient was diagnosed with hepatocellular carcinoma (HCC) based on the morphology of the cellular necrosis. In addition, occlusion due to thrombus was observed within the blood vessels passing inside the fibrous capsule. It was hypothesized that the formation of a thick fibrous capsule and occlusion due to thrombus in the feeding vessel were possibly involved as the cause of complete spontaneous necrosis. Written informed consent was obtained from the patient.

No MeSH data available.


Related in: MedlinePlus