Favorable response to multimodal treatment in hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus and left adrenal gland metastasis

Abstract

Rationale: Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related deaths and the sixth most commonly diagnosed cancer globally. Interdisciplinary and multimodal treatment strategies are essential for a successful therapy in HCC. Established therapies for HCC treatment include surgical resection, liver transplantation, local ablative therapies, transarterial chemoembolization (TACE), tyrosine kinase inhibitors (TKIs), immunotherapy, and radiotherapy (RT). Patient concerns: A 52-year-old male patient did an ultrasound scan and found a large mass within the right lobe of the liver and gallstones in December 2018. He had a history of chronic hepatitis C virus infection (30 years) and was treated with sofosbuvir (400 mg, q.d.) for 1 year. The patient never had any symptoms of gallstones. Enhanced abdominal computed tomography of this patient showed a heterogeneous irregular mass with the largest measurement of up to 13.7 × 11.1 cm in size in the right lobe of the liver, meanwhile also had inferior vena cava (IVC) tumor thrombus, right atrial (RA) tumor thrombus, and left adrenal gland metastasis. The laboratory test data revealed that the serum tumor marker α-fetoprotein was 2.63 ng/mL, cancer antigen 19-9 (CA 19-9) was 34.40 U/mL, and protein induced by Vitamin K absence was 391.94 mAU/mL. Diagnosis: HCC with IVC tumor thrombus, RA tumor thrombus, and left adrenal gland metastasis, and gallstones. Interventions: He was hospitalized and received TACE treatment, oral TKIs, intravenous drip programmed cell death-1 (PD-1) inhibitor and RT. Outcomes: The patient showed a favorable response after consecutive treatment with TACE, TKIs, PD-1 inhibitor, and RT. Until now, the patient has survived 34 months since the diagnosis of the disease. Lessons: Our case suggests that TACE combined with TKIs, PD-1 inhibitor, and RT may be a suitable treatment option for advanced HCC patients with IVC tumor thrombus and/or RA tumor thrombus, and/or adrenal gland metastasis.

Hepatocellular Carcinoma With Cardiac Metastasis Presenting as Presyncope

“…It is generally accepted that patients with HCC with extension into the right atrium are poor surgical candidates due to the complexities involved in the resection of the tumor in the IVC and the right atrium [ 8 , 9 ]. Other limiting factors of the surgical intervention include poor liver reserve, potential postoperative complications, and early recurrence [ 10 ]. Non-surgical approaches like the transarterial chemoembolization (TACE) procedure, chemotherapy, and radiotherapies have been attempted to palliate and improve quality of life.…”

Case Report: Radiotherapy Plus Immunotherapy and Lenvatinib for the Treatment of Recurrent Hepatocellular Carcinoma With a Right Atrium and Inferior Vena Cava Tumor Thrombus

“…An HCC patient with IVC and RA tumor thrombi and left adrenal gland metastasis received transarterial chemoembolization, immunotherapy, and subsequent radiotherapy. The patient survived for > 34 months since the disease diagnosis ( 34 ).…”

Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach

“…Tumor thrombus is a consequence of tumor invasion into the venous system, with activation of the coagulation and the simultaneous growth of both tumor and thrombus; it is rather frequent in the portal system in patients with hepatocarcinoma, but it can be observed also in the inferior vena cava invaded by a liver, gynecological or other abdominal cancers and requires a therapeutic approach not limited to anticoagulation (as is the case of simple thrombosis). 37 , 38 , 39 , 40 , 41 , 42 Tumor thrombi have been reported also in the pulmonary veins. 43 The histology‐based likelihood and the age of the patient at the time of presentation .…”

“…A right atrial mass without any relationship with the inferior vena cava and with the same echogenicity of intrapleural metastasis of sarcoma is probably a metastasis (Figure 1). Tumor thrombus is a consequence of tumor invasion into the venous system, with activation of the coagulation and the simultaneous growth of both tumor and thrombus; it is rather frequent in the portal system in patients with hepatocarcinoma, but it can be observed also in the inferior vena cava invaded by a liver, gynecological or other abdominal cancers and requires a therapeutic approach not limited to anticoagulation (as is the case of simple thrombosis) 37–42 . Tumor thrombi have been reported also in the pulmonary veins 43 …”