Abstract
A 71-year-old woman was diagnosed with a portal-hepatic venous shunt in 2003. In 2007, she developed hepatocellular carcinoma in the segment 6 of the liver and underwent partial hepatectomy. Computed tomography (CT) performed four years later showed a tumor in the medical segment of the liver. The patient had no previous history of blood transfusions, hepatitis, or metabolic abnormalities. On admission, the patient did not have impaired consciousness or general malaise, but she did have abnormal values for total bilirubin (T-Bil 1.7 mg/dL), NH3 (122 μg/dL), and the indocyanine green (ICG) 15-min retention rate (34%). CT showed a 3-cm-diameter tumor that was densely stained in the early stage and washed out in the inferior part of the medial segment of the liver, as well as a 17-mm-thick portovenous (PV) shunt connecting the anterior segmental branch of the portal vein to the middle hepatic vein.
Hepatic resection of the inferior part of the segment 4 was performed, the middle hepatic vein was sutured on the peripheral side, and the PV shunt was occluded. The pathological diagnosis was well-differentiated hepatocellular carcinoma.
The patient followed an uneventful course and was discharged on day 13 following surgery. The liver function tests normalized.
A case of a patient who, despite having no risk factors for liver cancer, twice developed hepatocellular carcinoma, was described.
