Hepatocellular carcinoma recurrence with portal vein thrombosis and bile duct thrombosis 6 years after percutaneous ethanol injection therapy: A case report

• Published in: Kanzo Vol. 60; no. 10; pp. 373 - 381
• Main Authors: Ota, Hideo, Yokoyama, Shigekazu, Miura, Yuto, Matsuno, Hiroshi, Takeoka, Tomohira, Konishi, Ken, Okada, Kazuyuki, Iio, Sadaharu, Fukunaga, Mutsumi, Kobayashi, Kenji
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Hepatology 01.10.2019
• Subjects: local biliary dilatation; PEIT; recurrent hepatocellular carcinoma; shunt formation; tumor thrombus
• ISSN: 0451-4203; 1881-3593
• DOI: 10.2957/kanzo.60.373

An 84-year-old man positive for hepatitis B surface antigen was diagnosed in June 200X with hepatocellular carcinoma. Abdominal computed tomography (CT) showed a 1-cm liver mass in S2/3. Percutaneous ethanol injection therapy (PEIT) was performed nine times. In January 200X, 6 years after PEIT, abdominal CT revealed B2 dilatation, suggesting cholangitis. Although the PIVKA-II level was increased, no mass was seen on CT. In April 200X, CT revealed an early-enhancing, 30 × 23-mm mass in S2 near the diaphragm, diagnosed as HCC with bile duct invasion (cT3, cN0, cM0, cStage III). The patient underwent left hepatectomy, left caudal resection, and cholecystectomy. The tumor was 43 mm in diameter and located near the left edge of the left hepatic vein. Pathology showed a moderately differentiated HCC (T3, N0, M0: Stage III) with vp3, b3. PEIT may lead to vascular and/or biliary shunts. Therefore, HCC recurrence in the same area may be prone to vascular invasion.