PMC3699313_01
Computed tomography demonstrated a cirrhotic liver with a 14.5 cm hepatocellular carcinoma (white arrow) in the right lobe (A) and an enlarged lymph node in the right anterior cardiophrenic area (black arrow, B).
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A computed tomography (CT) scan demonstrated findings typical of liver cirrhosis, an approximately 14.5 cm hypervascular mass in the right lobe of the liver without invasion of the middle hepatic vein, and an enlarged lymph node in the right anterior cardiophrenic space suggestive of metastasis in the lymph node (Figure 1A and B).
Scheme of therapy protocol. After CCRT with subsequent combined use of HAIC and sorafenib, the patient underwent OLT.. Abbreviations: HAIC, hepatic arterial infusion chemotherapy; 5-FU, 5-fluorouracil; RT, radiotherapy; CCRT, concurrent chemoradiation therapy; OLT, orthotopic liver transplantation.
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October 2009 (50 Gy with 20 fractions over 5 weeks with HAIC using 5-fuorouracil at a dose of 500 mg/day, which was administered during the first and fifth weeks of radiation therapy) via an implanted chemoport (Figure 2). One month after CCRT, the HCC decreased from 14.5 to 9.0 cm, and the metastatic lymph node in the right cardiophrenic area disappeared (partial response according to the modified Response Evaluation Criteria in Solid Tumors [RECIST]). HAIC following CCRT were completed by November 2010. However, sorafenib was maintained for an additional 2 years until the end of March 2012 (Figure 2).
Computed tomography scan before orthotopic liver transplantation demonstrated a decrease of the primary tumor to 6.4 cm with a large amount of ascites (A). A remarkable decrease in fluorodeoxyglucose uptake in the primary tumor was identified without visible distant metastasis on positron emission tomography and computed tomography (B).
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After the completion of 2 years of sorafenib monotherapy in March 2012, the size of the primary tumor had further decreased to 6.4 cm, and a suspicious HCC lesion that had developed after two cycles of HAIC had also disappeared (Figure 3A). In addition, a remarkable decrease in FDG uptake in the primary tumor was identified without visible distant metastasis on PET-CT (Figure 3B).
Macroscopic aspect and microscopic examination of liver specimen. Grossly, the liver showed macronodular cirrhotic change and a yellow necrotic mass (6.3 x 5.6 cm) at segment 4/8 (A). Microscopic examination showed complete necrosis of the hepatocellular carcinoma (B, hematoxylin and eosin, 100x).
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Grossly, the extracted liver showed mixed macro- and micronodular cirrhotic changes (Figure 4A). Microscopic examination showed total necrosis of the HCC and fibrous capsule formation (Figure 4B).