PMC5597876_01
Axial post-contrast CT scan shows left lobe mass, inferior vena cava filling defect and left portal vein thrombus..
gr1.jpg
PMC5597876_01_gr1.jpg
fig0005
Cooperative Oncology Group (ECOG) performance status score of 4 (completely disabled with severe limitations in selfcare and confined to bed or chair) and a Model for End-Stage Liver Disease (MELD) score of 24. Computed tomography (CT) demonstrated a diffuse irregular 7 cm soft tissue mass in the left lobe of the liver thought to be consistent with a HCC (Fig. 1).
Coronal T2-weighted magnetic resonance imaging showing mass in the inferior vena cava.
gr2.jpg
PMC5597876_01_gr2.jpg
fig0010
Extensive filling defects were seen within the IVC extending into the right atrium suggestive of thrombus (Fig. 2).
Angiogram of injection of contrast into the inferior vena cava demonstrating soft tissue mass. Filling defect of the inferior vena cava is also shown.
gr3.jpg
PMC5597876_01_gr3.jpg
fig0015
After successful guide-wire dilatation, a Labs 200 19-gauge liver biopsy catheter was advanced through the right atrium and into the IVC and several core biopsies were collected (Cook Medical Inc., Bloomington, Illinois, USA) under fluoroscopic and angiographic guidance (Fig. 3, Fig. 4).
Histopathology of the inferior vena cava hepatocellular carcinoma.
gr5.jpg
PMC5597876_01_gr5.jpg
fig0025
Histology demonstrated fragments of malignant tumour with features consistent with moderately differentiated hepatocellular carcinoma confirmed by immunoperoxidase staining (Fig. 5).