Metastatic lung tumor from hepatocellular carcinoma with tumor thrombus invasion in the pulmonary vein: a case report

• Published in: Journal of cardiothoracic surgery Vol. 18; no. 1; p. 167
• Main Authors: Ohtaka, Kazuto, Ohtake, Setsuyuki, Ishii, Yu, Kaku, Saya, Takeuchi, Yuta, Mizota, Tomoko, Yamamura, Yoshiyuki, Ichinokawa, Masaomi, Yoshioka, Tatsuya, Tamoto, Eiji, Murakawa, Katsuhiko, Ono, Koichi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.04.2023; BioMed Central; BMC
• Subjects: Aged; Biopsy; Blood clot; Blood clots; Blood vessels; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - surgery; Case Report; Case reports; Computed tomography; Development and progression; Embolisms; Health aspects; Hepatectomy; Hepatocellular carcinoma; Hepatoma; Humans; Image reconstruction; Kidney cancer; Laparoscopy; Liver cancer; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Lung cancer; Lung carcinoma; Lung Neoplasms - complications; Lungs; Lymphatic system; Male; Metastases; Metastasis; Metastatic lung tumor; Pulmonary Veins - pathology; Pulmonary Veins - surgery; Sarcoma; Segmentectomy; Segments; Stroke; Surgery; Thoracic surgery; Thorax; Three-dimensional computed tomography; Thrombosis; Thrombosis - etiology; Thrombosis - surgery; Tomography; Tumor thrombus; Tumors; Veins; Veins & arteries; Vitamin K; Hepatocellular carcinoma; Segmentectomy; Tumor thrombus; Three-dimensional computed tomography; Metastatic lung tumor
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02230-4

Metastatic lung tumor with a tumor thrombus in the peripheral pulmonary vein is very rare. We present a case of a metastatic lung tumor from hepatocellular carcinoma (HCC) with tumor thrombus invasion in the pulmonary vein that was diagnosed preoperatively and underwent complete resection by segmentectomy. A 77-year-old man underwent laparoscopic lateral segment hepatectomy for HCC eight years ago. Protein induced by vitamin K absence or antagonist-II remained elevated from two years ago. Contrast-enhanced chest computed-tomography (CT) showed a 27 mm nodule in the right apical segment (S1). He was pathologically diagnosed with a metastatic lung tumor from HCC via transbronchoscopic biopsy. We planned to perform right S1 segmentectomy. Before surgery, contrast-enhanced CT in the pulmonary vessels phase for three-dimensional reconstruction showed that the tumor extended into the adjusting peripheral pulmonary vein, and we diagnosed tumor thrombus invasion in V1a. The surgery was conducted under 3-port video-assisted thoracic surgery. First, V1 was ligated and cut. A1 and B1 were cut. The intersegmental plane was cut with mechanical staplers. Pathological examination revealed moderately-differentiated metastatic HCC with tumor thrombus invasions in many pulmonary veins, including V1a. No additional postoperative treatments were performed. As malignant tumors tend to develop a tumor thrombus in the primary tumor, it might be necessary to perform contrast-enhanced CT in the pulmonary vessel phase to check for a tumor thrombus before the operation for metastatic lung tumors.