Abstract
The efferent vessel of hepatocellular carcinoma (HCC) and the mechanism and pathogenesis of the high frequency of intrahepatic metastasis in HCC has not yet been clarified. Three hundred ninety-three resected specimens of HCC were examined for tumor thrombosis in the portal vein and the hepatic vein: 231 tumors ≤5 cm in diameter were examined for the relationship between mode of tumor spread and tumor size. Efferent vessels in HCC were identified by direct injection of radiopaque material into the tumor in 23 resected liver specimens and by percutaneous infusion of radiopaque media into tumor nodules in 8 patients. The mode of tumor spread in HCC progressed from capsular invasion to extracapsular invasion, then to vascular invasion, and finally to intrahepatic metastasis. There was a strong statistical correlation between the presence of intrahepatic metastasis and portal vein thrombosis (p<0.05, R=0.998). Radiopaque material injected directly into 23 resected tumors entered only the portal vein in 17 tumors and into both the portal and hepatic veins in 6 tumors. In all 8 patients with unresectable lesions, radiopaque media injected percutaneously into tumor nodules flowed only into the portal vein. These findings suggest that intrahepatic invasion by HCC may occur through the portal vein as an efferent tumor vessel.
Highlights
The prognosis ofhepatocellular carcinoma (HCC) has improved in recent years
The resected specimens were sliced at a thickness of about cm, and all of the slices were macroscopically examined for tumor thrombosis in the portal and hepatic veins
Portal vein tumor thrombosis was observed in 73 cases (18.6%) macroscopically, while, tumor thrombosis of the hepatic vein was confirmed in only 12 cases (3.1%)
Summary
The prognosis ofhepatocellular carcinoma (HCC) has improved in recent years. This is the result of refined surgical techniques, early detection of small tumors by advances in imaging techniques and biochemical diagnosis, and the introduction of percutaneous arterial embolization and ethanol infusion therapy. Facsimile number: 798-45-6581 intrahepatic metastases1’5’9-12 because HCC has a high frequency of tumor invasion into the portal vein system. The mechanism and pathogenesis of the high frequency of intrahepatic metastasis and portal invasion in HCC has not yet been clarified. To investigate the mechanism of intrahepatic metastasis and portal invasion, the pathological, radiological, and morphological studies were undergone to evaluate the efferent tumor vessels in HCC
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