Hepatocellular Carcinoma with Intra-Atrial Tumor Thrombi

Abstract

Background: In patients with advanced hepatocellular carcinoma (HCC), inferior vena cava/intra-right atrial (IVC/RA) tumor thrombi are not uncommon findings and are usually associated with extremely poor outcome. Surgical interventions as well as nonsurgical approaches, such as transcatheter arterial chemoembolization and radiotherapy, have been used in the treatment of patients with symptomatic IVC/RA tumor thrombi. However, such therapeutic modalities are usually not feasible when a patient shows poor general performance, the presence of metastatic disease, and underlying hepatic dysfunction. Such patients show limited survival. Material and Methods: Herein we describe 3 patients with advanced-stage HCC whose IVC/RA tumor thrombi and primary tumors regressed remarkably after low-dose thalidomide (200–400 mg/day) therapy. An Entrez PUBMED search of English Literature articles was performed to identify other cases of RA tumor thrombi in HCC who had received various treatments. Results: Two of our patients survived for more than 15 months after the diagnosis of IVC/RA tumor thrombi, while the other had effective symptomatic palliation associated with a drastic fall of AFP serum levels and significant tumor regression within 4 weeks of thalidomide therapy. A literature review suggested that the survival of our patients is comparable with that of occasional patients who had received aggressive surgical intervention. Conclusions: Our results suggest that, despite the low tumor response rate in earlier studies, thalidomide therapy may sometimes provide effective palliation for patients with far advanced HCC with symptomatic IVC/RA tumor thrombi and who are not candidates for alternative treatment options.

Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case

“…Most TTs from HCC extend continuously through the main hepatic vein into the right atrium, whereas an isolated TT in the right atrium is rare. 13 The clinical features related to a right atrial TT, such as dyspnea, tachycardia, abnormal cardiac sounds, was an encapsulated hepatocellular carcinoma (arrow) in segment 2-3. The tumor thrombus in the right atrium (arrowhead) measured 3.0 × 2.2 cm and was successfully removed en bloc with the main tumor syncope, and edema of the lower extremities, are attributed to right cardiac failure or pulmonary embolism.…”

A Case of Right Atrial Obliteration Caused by Intracardiac Extension of Hepatocellular Carcinoma

“…Case reports on the use of systemic therapy with atrial tumor involvement suggest potential survival benefit. In 3 patients with intra-atrial tumor thrombus treated with oral thalidomide, Chang et al [11] reported an overall survival of greater than a year. Additionally, in a case report by Vallakati et al [12], the patient experienced significant atrial tumor regression and symptom improvement after only 4 weeks of sorafenib treatment.…”

Right Atrial Mass in a Patient With HIV and Hepatitis B: A Case Report

“…Hepatocellular carcinoma has a great tendency towards venous invasion; however, extension of metastatic hepatocellular carcinoma into the right atrium was rarely reported [2-5]. Prognosis of hepatocellular carcinoma with cardiac metastasis is poor with median survival ranging from 1 - 4 months [6]. …”