Inferior vena cava tumor thrombus that directly infiltrated from paracaval lymph node metastases in a patient with recur
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Inferior vena cava tumor thrombus that directly infiltrated from paracaval lymph node metastases in a patient with recurrent hepatocellular carcinoma Shinya Imada1, Kohei Ishiyama1*, Kentaro Ide1, Tsuyoshi Kobayashi1, Hironobu Amano1, Hirotaka Tashiro1, Koji Arihiro2, Hiroshi Aikata3, Kazuaki Chayama3 and Hideki Ohdan1
Abstract Herein, we present the case of a patient with recurrent hepatocellular carcinoma (HCC) who had paracaval lymph node (LN) metastases with an inferior vena cava (IVC) tumor thrombus after a hepatectomy. A 65-year-old man with chronic hepatitis B virus infection received an extended anterior segmentectomy because of two hepatic tumors, located in segments 7 and 8. Histological examination of both resected specimens showed mostly moderately differentiated HCC with some poorly differentiated areas, and liver cirrhosis (A2/F4). Because the patient had an elevated α-fetoprotein serum level, abdominal computed tomography (CT) was performed. Abdominal CT revealed a 9-mm-diameter recurrent tumor in hepatic segment 3 and paracaval LN metastases with an IVC tumor thrombus at 8 months after the first operation. The patient received transcatheter arterial chemoembolization as treatment for the intrahepatic recurrence, following resection of the paracaval LN metastases and removal of the IVC tumor thrombus. In this case, the paracaval LN metastases had directly infiltrated the IVC via the lumbar veins, resulting in an IVC tumor thrombus, which usually develops from an intrahepatic tumor via the hepatic vein. The development of an IVC tumor thrombus with HCC recurrence, as in this case, is very rare, and based on a PubMed search, we believe this report may be the first to describe this condition. Keywords: Hepatocellular carcinoma, Lymph node metastases, Inferior vena cava tumor thrombus
Background Hepatocellular carcinoma (HCC) is a highly malignant form of cancer, which recurs frequently after hepatectomy [1]. The most common recurrent sites are the residual liver and lung; however, occurrence of lymph node (LN) metastases after hepatectomy is unusual [2]. Some studies have reported that metastatic LNs from HCC tend not to spread to the surrounding tissue [3]. Furthermore, in only 0.53% of patients with HCC did the inferior vena cava (IVC) have tumor invasion [4] that directly progressed from intrahepatic HCC. Therefore, local resection of HCC is a curative treatment to
improve patient survival. In our case, metastases from the LNs on the paracaval site, which is an uncommon site for HCC metastases, directly infiltrated into the IVC and developed into an IVC tumor thrombus. Although some investigators have reported that metastatic LNs infiltrated the portal venous (PV) wall and developed into PV tumor thrombi in patients with HCC [3], no reports have described IVC tumor thrombi from LN metastases in patients with recurrent HCC. In this report, we describe a rare progressive pattern of a recurrent HCC with LN metastases, which showed an infil
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