Prognosis for Pedunculated Hepatocellular Carcinoma

Horie, Yutaka; Shigoku, Azusa; Tanaka, Hisao; Tomie, Yasushi; Maeda, Naoto; Hoshino, Ushio; Koda, Masahiko; Shiota, Goshi; Yamamoto, Tetsuo; Kato, Seiichi; Murawaki, Yoshikazu; Suou, Takeaki; Kawasaki, Hironaka

doi:10.1159/000011996

Cited by 28 publications

(27 citation statements)

References 11 publications

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“…P-HCC was first described by Roux in 1897 (2), and represents 0.24-3.00% of all cases of HCC in Japan (3,4). Additionally, to the best of our knowledge, <200 cases have been reported in previous studies (4)(5)(6).…”

Section: Introductionmentioning

confidence: 83%

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Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

et al. 2018

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Abstract. Pedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, defined as a carcinoma protruding from the liver with or without a pedicle with a low degree of liver invasion. The present study aimed to evaluate the characteristics of blood supply of P-HCC prior to and following transcatheter arterial chemoembolization (TACE) treatment. Angiographic findings prior to and following TACE treatment in 39 patients with P-HCC were analyzed retrospectively. Angiography performed at the first TACE session revealed 70 tumor-feeding arteries collectively in all patients, including 31/70 (44.0%) extrahepatic parasitic arteries in 23/39 patients (59.0%). The intrahepatic arteries served as the main blood supply to P-HCC in all patients. Extrahepatic collateral blood supplies to P-HCCs were significantly associated with larger tumor diameter (χ 2 =164.000, P<0.001), but not tumor location (χ 2 =7.358, P=0.061). Following repeated TACE treatment, all angiographies revealed a total of 131 tumor feeding arteries collectively in all patients, including intrahepatic arteries (54/131) and extrahepatic collateral arteries (78/131) in 31 patients (79.5%). Compared with angiographies performed at the initial TACE treatment, these results also demonstrated an increase in the number of extrahepatic collateral arteries, which produced 47 new blood vessels (χ 2 = 4.278, P= 0.039). P-HCC tumor lesions readily acquired a parasitic blood supply from adjacent vessels following repeated TACE. Intrahepatic arteries functioned as the main blood supply for P-HCC, whereas extrahepatic collateral arteries were complementary to P-HCC, regardless of whether the patient was pre-or post-TACE. Extrahepatic collateral supplies to P-HCCs that originated from adjacent vessels were rich, were closely associated with tumor size, and were prone to be newly established following repeated TACE. IntroductionPedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, which is defined as a carcinoma protruding from the liver with or without a pedicle, and with a low degree of liver invasion (1). P-HCC was first described by Roux in 1897 (2), and represents 0.24-3.00% of all cases of HCC in Japan (3,4). Additionally, to the best of our knowledge, <200 cases have been reported in previous studies (4-6).The majority of P-HCC cases are treated surgically, with higher operability rates and better survival than conventional HCC, which may be due to its unique growth pattern, high rate of tumor capsule formation and lower vascular invasion (4-6). However, up to 39.4% of patients with P-HCC are unable to undergo surgical resection (7). Therefore, palliative treatments may serve a central function in the treatment of unresectable P-HCC. Transcatheter arterial chemoembolization (TACE) is the most widely used locoregional therapy for patients with intermediate HCC, who cannot be treated surgically (8-11). However, the blood supply to P-HCC is complicated, arising from hepatic arteries and extrahepatic collateral vessels (3). P-HCC tumor lesions prot...

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Section: Introductionmentioning

confidence: 83%

“…The majority of P-HCC cases are treated surgically, with higher operability rates and better survival than conventional HCC, which may be due to its unique growth pattern, high rate of tumor capsule formation and lower vascular invasion (4)(5)(6). However, up to 39.4% of patients with P-HCC are unable to undergo surgical resection (7).…”

Section: Introductionmentioning

confidence: 99%

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

et al. 2018

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“…La tumeur pédiculée naît le plus souvent des lobes accessoires du foie [3,6,7]. Une tumeur provenant du lobe droit a été rapportée dans trois cas [8,10,11], et une autre venant du lobe gauche dans deux cas [12,13].…”

Section: Commentairesunclassified

“…La plupart des carcinomes hépatocellulaires pédiculés décrits dans la littérature étaient moyennement ou peu diffé-renciés [13,14]. Le cas que nous rapportons montre un CHC bien différencié, comme celui décrit par Kotake [15].…”

Section: Commentairesunclassified

Carcinome hépatocellulaire pédiculé. À propos d’un cas

et al. 2010

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Malgré la fréquence élevée du carcinome hépato-cellulaire (CHC) dans nos régions, le CHC pédiculé reste très rare. Nous présentons une observation d'un CHC pédi-culé découvert chez un patient de 79 ans. L'examen clinique montrait une masse de la fosse iliaque droite de 12 cm occupant le flanc droit et la région périombilicale. L'échographie et l'examen tomodensitométrique évoquaient une tumeur coecale. La laparatomie exploratrice révélait une tumeur pédiculée du lobe droit du foie dont la résection complète a été faite. Le CHC pédiculé est plus favorable à une résection curative que le CHC conventionnel, et son pronostic est meilleur après une résection complète et en l'absence d'invasion vasculaire. Mots clés Hépatocarcinome pédiculé · Résection complèteAbstract Despite the high incidence of hepatocarcinoma in our country, the pedunculated hepatocarcinoma is very rare. We present a case of pedunculated hepatocarcinoma of a 79-year-old patient's. The clinical exam had shown a mass in the right iliac fossae, 12 cm wide from the right to the periumbilical region. The echography and the scanner showed a tumor of the cecum. The laparotomy had shown a pedunculated tumor of the right liver, and a complete resection of this mass was done. The pedunculated hepatocarcinoma is more favorable by curative resection to the conventional hepatocarcinoma, and its prognosis is better after a complete resection without vascular invasion.

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“…1 It has been reported to occur in 0.24%-3% of all HCC cases. 1 However, in spite of the high resectability rate, the postoperative prognosis is generally poor in patients with pedunculated HCC, [1][2][3] and, because there are few subjective symptoms and clinical findings, it is difficult to diagnose pedunculated HCC. In addition to recurrence in the remnant liver, peritoneal metastasis is one of the most frequent regions of recurrence in this type of HCC.…”

Section: Introductionmentioning

confidence: 99%

A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma

Kurachi

Suzuki

Yokoi

et al. 2002

Journal of Gastroenterology

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We report herein a 5-year survivor after the resection of peritoneal metastases from pedunculated hepatocellular carcinoma (HCC). A 42-year-old man underwent lateral segmentectomy of the liver, with a diagnosis of pedunculated HCC, on October 10, 1994. The lesion was associated with intratumoral hemorrhage and was covered by the greater omentum, but there were no peritoneal metastases. The patient was readmitted to our hospital 4 months later with right upper quadrant pain. His serum alpha-fetoprotein level was 3ng/dl. Hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCV-Ab) were both negative. Abdominal computed tomography (CT) revealed two nodular lesions in the right upper abdominal cavity. He was diagnosed with peritoneal metastases from HCC. Because there were no other distant metastases, laparotomy was performed to resect these tumors. We found two other tumors, located in the mesentery of the appendix and ileum. All four tumors were resected by partial transverse colectomy and appendectomy. The histopathology of the tumors showed poorly differentiated HCC (Edmondson-Steiner's grade III). The patient has been doing well without recurrent disease for more than 5 years after the second operation. The prognosis of patients with pedunculated HCC is poor. Furthermore, resection for peritoneal metastases from HCC is rare because of the presence of multiple seeding in the abdominal cavity and distant organ metastases. To our knowledge, our patient is the longest survivor after resection of peritoneal metastases from pedunculated HCC.

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Prognosis for Pedunculated Hepatocellular Carcinoma

Cited by 28 publications

References 11 publications

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Carcinome hépatocellulaire pédiculé. À propos d’un cas

A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma

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