Hepatocellular Carcinoma with Tumor Thrombus Extending from the Portal Vein to the Right Atrium

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 thr...

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Published inCurēus (Palo Alto, CA) Vol. 11; no. 5; p. e4689
Main Authors Numan, Laith, Asif, Samia, Abughanimeh, Omar K
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 17.05.2019
Cureus
Subjects
Abdomen
Blood clots
Case reports
Catheters
Embolisms
Esophagus
Gastroenterology
Heart failure
Internal Medicine
Liver cancer
Liver cirrhosis
Medical imaging
Medical prognosis
Metastasis
Mortality
NMR
Nuclear magnetic resonance
Oncology
Pain
Patients
Veins & arteries
United States > US
poor prognosis
esophageal variceal bleeding
tumor thrombus
hepatocellular carcinoma
liver cirrhosis
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Summary: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.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.4689