A resected case of stage IV hepatocellular carcinoma 5 years and 9 months after one shot arterial infusion chemotherapy

Abstract

A 72-year-old female was admitted to our hospital with complaints of general malaise, appetite loss, nausea, and vomiting in January, 1984. CT showed large tumor in the right lobe. Ultrasound revealed large tumor in the right lobe, tumor thrombi in the right main branch of the portal vein, and ascites. A sign of mild hepatic encephalopathy was also observed. Serum α-fetoprotein level was 25118 ng/ml. Angiography revealed multiple small hypervascular nodules in the right lobe and extremely extended arterio-portal shunting (A-P shunt), which is consistent with the diagnosis of hepatocellular carcinoma (HCC). The tumor and A-P shunt drastically disappeared on US, CT, colloid liver scan, and angiography a few months after the injection of 10mg of mitomycine C through the common hepatic artery. Five years and 9 months after one shot arterial infusion chemotherapy, the recurred HCC, measuring 1.9cm in size was treated with the second arterial infusion chemotherapy combined with lipiodol followed by a right lobectomy. The histopathology showed total necrosis of HCC, multiple organization and fibrosis in the right lobe, and thickened organized lesion with fibrosis within the portal vein.
This case is considered to be rare since stage IV HCC responded extremely well to the single arterial infusion chemotherapy as well as the scars of HCC lesion and tumor thrombi in the portal vein were recognized pathologically more than 5 years later.