Saito M, Seo Y, Yano Y, Uehara K, Hara S, Momose K, Hirano H, Yokozaki H, Yoshida M, Azuma T

Language: English
References: 19
Page: 969-973
PDF size: 195.00 Kb.

ABSTRACT

The patient was a 43-year-old man with chronic hepatitis B without history of hepatocellular carcinoma (HCC), who was first diagnosed with thrombosis in right portal vein trunk and portal vein branches and ruptured esophageal varices in October 2011. He underwent endoscopic variceal ligation, but ruptured repeatedly. Despite anti-coagulant therapy, the thrombosis expanded from right portal vein trunk to upper mesenteric vein in March 2012. Computed tomography (CT) scan showed that portal vein thrombosis had low density from early to late phase. No focal liver lesions were identified by CT scan or ultrasound, and alpha-fetoprotein (AFP) was within normal range. He died by intractable esophageal variceal bleeding in April 2012. Pathological examination of autopsy specimen showed that portal vein thrombosis was consistent with poorly-differentiated HCC. The portal vein tumor thrombosis (PVTT) had only a few tumor vessels, which were compressed by fibromatous change originating from HCC formation, so were represented as low-density lesions from arterial to portal phase of CT. In addition, PVTT was negative for AFP, so representing serum value of AFP within normal range. PVTT had positive staining for c-kit, which is a liver stem cell marker. Liver tumors in the whole liver parenchyma were not found pathologically. PVTT might have the characteristics of presumed liver cancer stem cells. We experienced the first case of HCC only in portal vein without liver parenchyma tumor nodules, with difficult differential diagnosis from a non-malignant portal vein thrombosis. We also reported new tumor profiles of the portal venous tumor growth- type of HCC.

REFERENCES

1. Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma Y, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer 2004; 101: 796-802.

2. Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 2006; 243: 229- 35.

3. Ikai I, Arii S, Ichida T, Okita K, Omata M, Kojiro M, Takayasu K, et al. Report of the 16th follow-up survey of primary liver cancer. Hepatol Res 2005; 32: 163-72.

4. Chen JS, Wang Q, Chen XL, Huang XH, Liang LJ, Lei J, Huang JQ, et al. Clinicopathological characteristics and surgical outcomes of hepatocellular carcinoma with portal vein tumor thrombosis. J Surg Res 2012; 175: 243-50.

5. Jia L, Kiryu S, Watadani T, Akai H, Yamashita H, Akahane M, Ohtomo K. Prognosis of hepatocellular carcinoma with portal vein tumor thrombus: assessment based on clinical and computer tomography characteristics. Acta Med Okayama 2012; 66: 131-41.

6. Qi X, Han G, He C, Yin Z, Guo W, Niu J, Fan D. CT feature of non-malignant portal vein thrombosis: a pictorial review. Clin Res Hepatol Gastroenterol 2012; 36: 561-8.

7. Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000; 32: 865-71.

8. De Stefano V, Martinelli I. Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med 2010; 5: 487-94.

9. Lertpipopmetha K, Auewarakul CU. High incidence of hepatitis B infection-associated cirrhosis and hepatocellular carcinoma in the southwest asian patients with portal vein thrombosis. BMC Gastroenterol 2011; 11: 66.

10. Arii S, Tanaka J, Yamazoe Y, Minematsu S, Morino T, Fujita K, Maetani S, et al. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer 1992; 69: 913-9.

11. Kojiro M. Pathology of hepatocellular carcinoma. Oxford: Blackwell Publishing; 2006, p. 63-75.

12. Ye QH, Qin LX, Forgues M, He P, Kim JW, Peng AC, Simon R, et al. Predicting hepatitis B virus-positive metastatic hepatocellular carcinomas using gene expression profiling and supervised machine leaning. Nat Med 2003; 9: 416-23.

13. Shuqun C, Mengchao W, Han C, Feng S, Jiahe Y, Guanghui D, Wenming C, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology 2007; 54: 499-502.

14. Guo W, Xue J, Shi J, Li N, Shao Y, Yu X, Shen F, et al. Proteomics analysis of distinct portal vein tumor thrombi in hepatocellular carcinoma patients. J Proteome Res 2010; 9: 4170-5.

15. Fujio K, Hu Z, Evarts RP, Marsden ER, Niu CH, Thorgeirsson SS. Coexpression of stem cell factor and c-kit in embryonic and adult liver. Exp Cell Res 1996; 224: 243-50.

16. Fujio K, Evarts RP, Hu Z, Marsden ER, Thorgeirsson SS. Expression of stem cell factor and its receptor, c-kit, during liver regeneration from putative stem cells in adult rat. Lab Invest 1994; 70: 511-6.

17. Becker FF, Sell S. Differences in serum alpha-fetoprotein concentrations during the carcinogenic sequences resulting from exposure to diethylnitrosamine or acetylaminofluorene. Cancer Res 1979; 39: 1437-42.

18. Fujita N, Aishima S, Iguchi T, Mano Y, Taketomi A, Shirabe K, Honda H, et al. Histologic classification of microscopic portal venous invasion to predict prognosis in hepatocellular carcinoma. Hum Pathol 2011; 42: 1531-8.

19. Jang HJ, Kim TK, Burns PN, Wilson SR. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 2007; 244: 898-906.