Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium

Kanematsu, Masayuki; Imaeda, T; Minowa, Hideki; Yamawaki, Y; Mochizuki, Ryozo; Goto, Hironobu; Seki, Matsuzo; Doi, Hidetaka; Okumura, Satoru

doi:10.1007/bf00198186

Cited by 31 publications

(19 citation statements)

References 12 publications

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“…Se ha descrito igualmente la invasión metastásica de la vena cava inferior y de la aurícula derecha (4)(5)(6)(7)(8). En pacientes con hepatocarcinoma, las metástasis en aurícula derecha como resultado de la invasión directa y extensión a través de la vena cava inferior son extremadamente infrecuentes (9,10).…”

Section: Discussionunclassified

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

Fernández

Amado

Bello

et al. 2003

An. Med. Interna (Madrid)

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RESUMENEl hepatocarcinoma tiene tendencia a invadir estructuras vasculares. Es infrecuente, sin embargo, la afectación de las venas hepáticas y las metástasis intracardíacas. Presentamos el caso de un varón de 68 años con hepatopatía crónica por virus C, que consulta por edema y dolor a nivel del miembro inferior izquierdo. Mediante eco doppler, se objetivó, trombosis venosa profunda a dicho nivel y el TAC tóraco-abdominal, mostró, trombosis completa de la vena cava inferior, trombosis de la vena suprahepática izquierda, un voluminoso trombo en aurícula derecha y una masa irregular en hígado. La alfafetoproteína fue de 77.046 ng/ml. La biopsia del trombo de aurícula derecha estableció el diagnóstico de hepatocarcinoma. Se comenta la evolución del paciente tras la intervención quirúrgica, la frecuencia y clínica de esta complicación y las posibilidades terapéuticas en estos pacientes. HEPATOCELLULAR INVOLVING VASCULAR STRUCTURES AND HEART: DIAGNOSIS AND TREATMENT INTRODUCCIÓNEl carcinoma hepatocelular tiene tendencia a invadir las venas hepáticas (y a través de ellas, puede extenderse al lado derecho del corazón) así como la vena porta, en sus estadíos avanzados (1). Esta invasión vascular puede, no obstante, ser una complicación temprana que no indica necesariamente inoperabilidad del tumor, lo que pone de manifiesto la importancia de su diagnóstico (2). La incidencia de trombosis o afectación vascular es mucho más frecuente (13%) en casos de hepatocarcinoma que en tumores metastásicos (5%) o cirrosis (5%) (2).En general, existe una clara asociación entre tromboembolismo venoso y cáncer, sobre todo en pacientes mayores de 40 años. No obstante, sólo está justificado un screening invasivo de tumor primario ante la presencia de algún signo guía (3).Exponemos el caso de un paciente con carcinoma hepatocelular, trombosis venosa masiva y extensión a cavidades cardiacas derechas, comentando las técnicas diagnósticas utilizadas, tratamiento y evolución. CASO APORTADOVarón de 68 años de edad, sin antecedentes patológicos de interés, que consulta por edema y dolor a nivel de miembro inferior izquierdo. El paciente había sido estudiado ambulatoriamente por náuseas y dolor epigástrico detectándose en la analítica sanguínea aumento de transaminasas y serología positiva para hepatitis C. A la exploración física, el paciente presentaba buen estado general, ictericia conjuntival e ingurgitación venosa yugular. A nivel abdominal, existía circulación colateral sin semiología de ascitis y hepatomegalia de 2-3 cm. El miembro inferior izquierdo estaba edematoso y el

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Section: Discussionunclassified

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

Fernández

Amado

Bello

et al. 2003

An. Med. Interna (Madrid)

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“…Inhomogeneous enhancement is seen on late Gd imaging (j-l). Note the presence of multiple, nodular pulmonary lesions, representing pulmonary metastases (arrows, b) b e.g., adrenocortical carcinoma (Ritchey et al 1987;Godine et al 1990), hepatocellular carcinoma (Kanematsu et al 1994), Wilms' tumor (Gibson et al 1990), renal cell carcinoma (Paul et al 1975), recurrent pheochromocytoma (Rote et al 1977), endometrial stromal carcinoma (Phillips et al 1995), and thyroid carcinoma (Thompson et al 1978). Its presence is potentially hazardous because it can cause caval obstruction, extension of the tumor thrombus into the right atrium causing atrial occlusion, and tumor embolization.…”

Section: Venous Extensionmentioning

confidence: 99%

Cardiac Masses

Bogaert¹,

Dymarkowski²

2011

Clinical Cardiac MRI

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“…Tumor emboli have and the development of an endothelial cell lining are likely to help tumor thrombi become established within the vascular been observed in the circulation of patients with various types of cancer. [15][16][17][23][24][25] Circulating tumor emboli occur most lumen. However, the presence of necrotic thrombo-emboli within the pulmonary vessels suggested that adherence to commonly in patients with renal carcinoma and HCC, which reflects the propensity of these tumors to invade local venous the vascular wall and endothelialization were not sufficient for their survival.…”

Section: Aid Hepa 0034mentioning

confidence: 99%

“…Intravenous tumor expansion was frequently accompanied by the appearance of CD31-positive been linked to the propensity of these tumors to invade local microvessels within the tumor thrombi and fibrous perivascu-venous structures. [14][15][16][17] In rodent models, the cellular and lar thickening, giving rise to isolated tumor nodules within biochemical aspects of hepatocarcinoma genesis have been the portal areas. Intravascular expansion of disseminating studied extensively.…”

mentioning

confidence: 99%

Morphological study of vascular dissemination in a metastatic hepatocellular carcinoma model in the monkey

Lindsay¹

1997

Hepatology

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In this report we describe a metastatic monkey hepatocellu-cinoma (HCC) has been associated with several types of liver diseases such as hepatitis and cirrhosis. 10,11 In HCC, the lar carcinoma (HCC) model in which intravascular metastatic development is clearly evident. The tumor-bearing livers con-phase of accelerated tumor growth and metastasis appears to coincide with the emergence of the tumor vasculature, which tained intravenous tumor thrombi at different stages of progression within the small branches of the portal vein. These is derived mainly from the hepatic artery.12,13 HCC frequently disseminates intrahepatically through the portal vascular ranged from mural tumor thrombi lined with CD31-positive endothelial cells to tumor thrombi that had completely oc-channels.14 Tumor microemboli are often found in the circulation of patients with HCC and renal carcinoma. This has cluded the vascular lumen. Intravenous tumor expansion was frequently accompanied by the appearance of CD31-positive been linked to the propensity of these tumors to invade local microvessels within the tumor thrombi and fibrous perivascu-venous structures. [14][15][16][17] In rodent models, the cellular and lar thickening, giving rise to isolated tumor nodules within biochemical aspects of hepatocarcinoma genesis have been the portal areas. Intravascular expansion of disseminating studied extensively. 18 In the present monkey carcinogenesis HCC was also evident within small branches of the pulmonary model, HCC was induced by a food-derived heterocyclicaarteries in the lungs. These findings indicate that metastases mine, 2-amino-3-methylimidazo[4,5-f]quinoline (IQ), which of HCC can become established while still at an intravascular was previously reported to be a multiorgan carcinogen in stage, suggesting that the direct interaction between tumor rodents.19 This nonhuman primate model provided a rare cells and parenchymal cells predicted from experimental ro-opportunity to study the morphology of intrahepatic vascular dent metastasis models is not a prerequisite for the metastatic dissemination and seeding of tumor cells in the pulmonary development of these tumors. (HEPATOLOGY 1997;26:1209-vasculature by chemically induced HCC. The results pre-1215. ) sented here suggest that the intravascular phase of metastatic development in HCC is more prolonged than has been predicated from rodent metastasis models. Tumor metastasis is a complex multi-step process.1,2 Studies of the metastatic process using rodent models, in which MATERIALS AND METHODShighly invasive tumor cells are injected into the systemic Monkey Tissues. The tissues used in this study were obtained from circulation, have led to the proposal that tumor cells must 34 cynomolgus monkeys (Macaca fascicularis), who developed liver be able to exit the circulation and grow within the organ tumors as a result of chronic exposure to IQ. 20 These monkeys were parenchyma to form metastases.2 Angiogenesis has also been born and raised in a closed colony and stayed with their mothers s...

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Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium

Cited by 31 publications

References 12 publications

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

Trombosis venosa masiva con invasión cardiaca como primera manifestación de un hepatocarcinoma

Cardiac Masses

Morphological study of vascular dissemination in a metastatic hepatocellular carcinoma model in the monkey

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