Case of hepatocellular carcinoma with splenic and portal vein thrombosis treated by TAE

Abstract

A 50-year-old man was hospitalized with the chief complaints of abdominal pain and fever. Results of various kinds of medical imagings led to the diagnosis of hepatocellular carcinoma (HCC) with metastasis to the spleen and tumor thrombi in the portal and splenic veins. An operation was not possible, and we gave one arterial injection of anticancer agents and did transcatheter arterial embolization (TAE) twice, with about one month between one treatment and the next. After each TAE, the tumor grew smaller, and after the second TAE, the splenic vein thrombus was not found. Metastasis to the spleen is rare in HCC and splenic vein thrombi have not been reported before, to our knowledge. That a tumor thrombus was found in the drainage vein of the metastatic lesion as well as that of the main lesion is of importance to a discussion of the mechanism of such thrombi. The effect of TAE treatment suggests that the metastatic lesion in the spleen and the tumor thrombus in the splenic vein were supplied by arterial tumor vessels.