PMC4429844_01
Contrast enhanced CT scan shows an enhancing 12 mm tumor in the arterial phase (arrow) and wash-out in the equilibrium phase (arrowhead), consistent with an HCC in segment 8.
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He underwent contrast enhanced computed tomography (CT) scan which showed a 12 mm tumor which enhanced in the arterial phase and washed out in the equilibrium phase in segment 8, consistent with HCC (Fig 1).
Enhanced CT scan in the arterial phase shows an enhancing recurrent tumor (upper; arrow) and a relatively hypervascular area due to portal vein thrombus. In the equilibrium phase, the main tumor was washed-out (lower; arrow) and a right portal vein was totally occluded by a tumor thrombus (arrowhead).
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The right portal vein was totally occluded 144 days after RFA (Fig 2).
The first TAI treatment was done through an injection in the anterior sectional branch of the right hepatic artery (A5/A8). At the same time, we confirmed accumulation of iodized oil in the main lesion and portal vein tumor thrombus with plain CT imaging (arrowhead).
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The first TAI treatment was given 146 days after RFA, using miriplatin 120 mg and iodized oil 11 ml through an anterior sectional branch of the right hepatic artery (A5/A8) and confirmed accumulation of iodized oil in the main lesion and portal vein thrombus (Fig 3).
Enhanced CT scan in the portal phase shows a markedly decrease in size of the main lesion (arrow) and portal vein tumor thrombus. The posterior sectional branch of right portal vein was recanalized (arrowhead).
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At 265 days after RFA, a contrast enhanced CT scan showed a marked decrease in size of the main lesion and recanalization of the posterior sectional branch of right portal vein (Fig 4).
Macroscopic findings showed a yellowish tumor in the liver (arrow) and an 18 mm-sized whitish area adjacent to it (arrowhead). Microscopic findings showed collapse of the liver parenchyma (upper; a part of arrow, H.E. stain x 4), coagulation necrosis of the tumor (middle; a part of arrowhead, H.E. stain x 4) and organized thrombus in the portal vein (lower; Elastica van Gieson stain x 4). All areas had no viable tumor cells.
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Collapse of the liver parenchyma and organization of the thrombus in the portal vein were found with no malignant cells (Fig 5).