Abstract
BackgroundMacroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis. Additionally, triple-positive tumor marker status is a predictor of poor outcome even after hepatectomy. Sorafenib is recommended in such patients, but it has limited therapeutic effectiveness.Case presentationA 54-year-old man was diagnosed with a liver abscess that was treated by puncture and drainage at a regional hospital. However, the diagnosis was subsequently changed to hepatocellular carcinoma with macroscopic portal vein tumor thrombus, based on the results obtained for the triple-positive tumor markers (alpha-fetoprotein, 45,928 ng/ml; protein induced by vitamin K absence or antagonist-II, 125,350 mAU/ml; and alpha-fetoprotein-L3, 38.3%). As the patient’s liver functional reserve was not adequate for curative resection, chemoembolization was performed with a hepatic arterial infusion of cisplatin (50 mg) and 5-FU (1000 mg), followed by mild embolization with cisplatin (50 mg) suspended in lipiodol (5 ml) and starch microspheres (300 mg) containing mitomycin C (4 mg). As the thrombus had progressed to the bifurcation of the right and left portal veins, the right vein was surgically ligated. Three peritoneal nodules could be identified and were removed. Three additional rounds of hepatic arterial chemotherapy/chemoembolization were performed after the initial surgery. At the 2-year evaluation, all tumor markers were observed to have normalized and diagnostic imaging showed complete remission.ConclusionsComplete remission of hepatocellular carcinoma with macroscopic portal vein tumor thrombus and peritoneal dissemination was obtained with a treatment regimen that involved four rounds of hepatic arterial infusion chemotherapy and transient chemoembolization, portal vein ligation, and the removal of peritoneal dissemination. This regimen can be recommended for patients with advanced hemiliver lesions who cannot undergo curative resection.
Highlights
Macroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis
Complete remission of hepatocellular carcinoma with macroscopic portal vein tumor thrombus and peritoneal dissemination was obtained with a treatment regimen that involved four rounds of hepatic arterial infusion chemotherapy and transient chemoembolization, portal vein ligation, and the removal of peritoneal dissemination
We report a case of complete remission of a diffuse-type hepatocellular carcinoma (HCC) with PVTT after four rounds of transient chemoembolization combined with surgical portal vein ligation (PVL) and extirpation of peritoneal dissemination
Summary
A treatment consisting of chemoembolization and surgical intervention, including PVL, may allow complete remission in patients with advanced hemiliver lesions, PVTT, and/or localized peritoneal dissemination. Authors’ contributions YK and TB mainly participated in the conception, design, and analysis of this case report and drafted the manuscript. KI, KK, TM, YK, SN, HO, KO, YY, and AC conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript. Consent for publication Written informed consent was taken from the patient for publication of this case report and all accompanying imaging. Competing interests The authors declare that they have no competing interests. Author details 1Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan. Author details 1Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan. 2Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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