Journal of Liver Cancer

Chae Yoon Chon

17 Articles

A Case of Partial Response of Hepatocellular Carcinoma Induced by Concurrent Chemoradiation and Hepatic Arterial Infusion Chemotherapy after Trans-Arterial Chemoembolization: Myung Eun Song, Sangheun Lee, Mi Na Kim, Dong-Jun Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han, Jinsil Seong, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):152-157. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.152

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Abstract PDF: A 63-year-old man patient was referred for treatment of infiltrative hepatocellular carcinoma with hilar invasion after transarterial chemoembolization. Serum alkaline phosphatase and bilirubin were elevated, liver dynamic CT showed infiltrative type mass in left hepatic lobe and right hepatic dome with hilar invasion and left intrahepatic duct dilatation. Also CT showed obliteration of left portal vein and metastasis of lymph node around common bile duct. He was diagnosed as hepatocellular carcinoma (UICC stage IV-A, BCLC stage C). With the percutaneous transhepatic biliary drainage and the concurrent chemoradiation therapy and the 4th cycle of hepatic arterial infusion chemotherapy for infiltrative mass, viable tumor was decreased in resectable size at eight months from initial diagnosis.

A Case of Recurred Hepatocellular Carcinoma after Treated by Trans-Arterial Chemoembolization: Sangheun Lee, Mi Na Kim, Young Eun Chon, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han; Journal of the Korean Liver Cancer Study Group. 2013;13(1):74-79. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.74

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Abstract PDF: Hepatocelluar carcinoma (HCC) is the most common primary liver cancer in the world and the most prevalent cancer among patients liver cirrhosis. The management of HCC depends on tumor stage and the degree of liver dysfunction. Patients with intermediate-stage HCC are ineligible for surgical or local ablative treatments. Current treatment guidelines recommend trans-arterial chemoembolization (TACE) for intermediate stage of HCC. However, tumor recurrence after TACE is universal and the survival benefit is relatively small. Hence, new strategies are needed to improve the outcome of HCC patients undergoing TACE. Recently, the combination of target agents with TACE has shown promising overall survival in advanced HCC. It is necessary to investigate new treat strategy how to increase treatment outcome of advanced HCC by new treat strategy.

A Case of Necrotizing Pancreatitis after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Mi Na Kim, Jung Hyun Cho, Young Eun Chon, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon; Journal of the Korean Liver Cancer Study Group. 2012;12(2):155-159. Published online September 30, 2012

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Abstract PDF: Acute pancreatitis is a rare but severe postprocedural complication after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma with an incidence of 1.7-4%. The proposed mechanism of this complication is inadvertent embolization through collateral vessels or regurgitation of chemotherapeutic agents to the arteries of other organs. Here, we present a fatal necrotizing pancreatitis case which developed 10 days after TACE, caused by the regurgitation of the chemotherapeutic agents to the pancreas during the procedure. The patient recovered with conservative care at first, but after suffering from several times of recurrent pancreatitis, he died of peritoneal septic shock 5 months after the initial pancreatitis attack.

A Case of Advanced Hepatocellular Carcinoma which was Supervening with Renal Cell Cancer Cured by Repeated Transarterial Chemoembolization and Sorafenib after Resection: Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57. Published online February 28, 2012

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Abstract PDF: Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected 2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil (FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.

A Case of Hepatocellular Carcinoma Recurred Extensively during Treatment of Biliary Complication Occurring after Transarterial Chemoembolization: Hyun Jung Oh, Hana Park, Kwang Hoon Lee, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon, Jun Yong Park; Journal of the Korean Liver Cancer Study Group. 2011;11(2):178-184. Published online September 30, 2011

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Abstract PDF: Hepatocellular carcinoma(HCC) is one of the cancers with poor prognosis. Transarterial chemoembolization(TACE) has been widely used for treating unresectable HCC. Although TACE is considered as a less invasive and relative safe procedure, severe complications such as hepatic failure, pulmonary embolism, liver abscess, biloma formationcan occur rarely after TACE. These complications sometimes may lead to fatal clinical situation, even death. We reported a case of HCC recurred extensively during treatment of biliary complication after TACE. A 44-year-old male with HCC was admitted due to fever for 3 days after undergoing TACE. Three weeks before the admission, he had been diagnosed with HCC recurrence which presented as two arterial enhancing nodules in MRI and treated with TACE. CT scan showed 7 cm sized air containing fluid collections with necrosis suggestive of liver abscess and 15 cm sized biloma formation. Because the patient was in septic shock at admission, percutaneous catheter drainage was performed with use of broad spectrum antibiotics. After treatment of 3 months, the sizes of hepatic abscess and biloma were remarkably decreased. However, 1 month later, large size tumor recurrence and perihepatic lymph node metastasis were found on a follow-up CT scan. In this case, the cause of rapid growing recurrence after TACE is uncertain, but the development of unanticipated complication seems to affect the progression to poor prognosis. Therefore, early recognization of predisposing factors with proper management would be needed to prevent these serious complications after TACE.

A Case of Hepatocellular Carcinoma showing Progressive Disease in Systemic Chemotherapy, but Partial Response in Hepatic Arterial Infusion Chemotherapy with the Same Regimen: Soung Min Jeon, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Jun Yong Park; Journal of the Korean Liver Cancer Study Group. 2010;10(1):44-48. Published online June 30, 2010

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Abstract PDF: Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea. Despite recent advances in the area of HCC, a considerable number of HCC patients require non-surgical treatments and systemic therapies because of poor liver function or intermediate to advanced cancer stages at the time of diagnosis. Unfortunately, chemotherapy for advanced HCC has limited response rates and provides a marginal survival benefit. Several studies have supported potential advantages of hepatic arterial infusion chemotherapy (HAIC), designed to improve chemotherapy benefits by increasing the amount of chemotherapy delivered to the site of the tumor and to minimizes the side-effects of the chemotherapy. However, there hasn’t been any report showing different responses between systemic chemotherapy and HAIC for the same patient. Herein, we report a case of HCC showing progressive disease in systemic chemotherapy, but partial response in HAIC with the same regimen for the same patient with portal vein thrombosis. This case implies HAIC might be alternative option for HCC patient showing ineffective response to systemic chemotherapy, even with the same regimen.

A Case of Early Recurred Hepatocellular Carcinoma with Initial Expectation of Good outcome by Surgical Resection: Jung Min Lee, Jun Yong Park, Do Young Kim, Kyung Sik Kim, Young Nyun Park, Myeong-Jin Kim, Chae Yoon Chon, Kwang-Hyub Han; Journal of the Korean Liver Cancer Study Group. 2009;9(1):41-44. Published online June 30, 2009

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis as HCC develops on base of cirrhosis in majority cases, which requires multidisciplinary approach. If feasible, however, surgical resection is the choice of treatment, and many previous studies and guidelines offered appropriate indications for surgical resection; firstly, preservation of liver function should be confirmed with traditional Child-Pugh classification or more recently with Indocyanine Green retention test or absence of portal hypertension. Secondly, several variables about the size, number, and vascular invasion of tumor should be taken into consideration. It is suggested that to lessen the risk of recurrence gross vascular invasion be absent and the number of tumor be single. Regarding the size of tumor, although risk of dissemination increases with size, some tumors may grow as a single mass and thus the size of tumor is not a clear-cut limiting factor. Based on above suggestions, we herein offer our experience of a patient with initial hopeful expectation of good outcome with surgical resection, but who eventually turned out to result in disseminated tumor recurrence. Further study, maybe regarding a combination of adjuvant or neoadjuvant transarterial chemoembolization/chemotherapy or radiotherapy, is necessary on how to manage such patient.

A Case of Hepatocellular Carcinoma in Young Age Younger than 20 Years Old: Joo Won Chung, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon, Geung-kyu Ko, Jin Sil Seong, Jong Hee Chang, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):71-75. Published online June 30, 2009

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Abstract PDF: Hepatocellular carcinoma (HCC) is very rare in young age. Most young patients tend to receive the evaluation only when they experience intractable or persistent symptoms. Therefore, HCC in young patients is often diagnosed at advanced stage and thus, young HCC patients have a worse prognosis than older HCC. However, because young HCC patients show well-preserved liver function than older HCC, they are tolerable to more aggressive treatments. We report a case of advanced HCC in 13-year and 8-month old male who has been a B-viral carrier. Despite the tumor size decreased after concurrent chemoradiation therapy, multiple lung and brain metastases developed. He underwent radiofrequency ablations on lung metastases and gamma-knife surgery on brain metastasis, and he has received systemic and intra-arterial chemotherapy. The screening and early diagnosis of HCC in young age is needed especially for B-viral carrier with a family history of HCC.

A Case of Hepatocellular Carcinoma in a Pregnant Patient in Twenties: Kang Kook Choi, Young Ju Hong, Sae Byeol Choi, Nam Joon Yi, Shin Hwang, Young Nyun Park, Jin Sub Choi, Kyung Suk Suh, Chae Yoon Chon, Kyung Sik Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):76-81. Published online June 30, 2009

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Abstract PDF: Hepatocellular carcinoma (HCC) in pregnancy is very rare. The cirrhosis which is present in the majority of patients with HCC induces infertility. The diagnostic methods and treatment modalities in HCC during pregnancy are different from those of usual types of other HCC. A 26-year-old, 32th-gestational-week pregnant female was sent to our hospital because of abnormal liver function test. A 1.5cm sized mass was identified in segment 6 of liver which was compatible to AJCC stage I. She did not have any other medical history except Hepatitis B Virus carrier and the HBs Ag of her mother also was positive. At the 40th gestational week, the female baby was delivered uneventfully. And then she underwent the transarterial chemoembolization (TACE) following the Rt. Hemihepatectomy. Since she underwent a surgical resection, the tumors have been recurred in the remnant liver only. Whenever the tumors were founded, the aggressive surgical approaches were performed including 3 times of hepatic resection with TACE or TACI. She is still alive with good general condition and normal liver function for 9 years since the first diagnosis was made. Therefore an extremely rare case of hepatocellular carcinoma in pregnancy is treated successfully because of aggressive therapies.

A Case of Curative Resection of Advanced Hepatocellular Carcinoma After Localized Concurrent Chemo-Radiation Therapy: Wonseok Kang, Ki Tae Yoon, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Chae Yoon Chon, Kyung Sik Kim, Young Nyun Park, Jin Sil Seong, Kwang Hyub Han; Journal of the Korean Liver Cancer Study Group. 2008;8(1):98-101. Published online June 30, 2008

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Abstract PDF: Most patients with advanced hepatocellular carcinoma (HCC) are not suitable candidates for surgical treatment at the time of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients having locally advanced HCC with vascular involvement and preserved hepatic function. We report a case of locally advanced HCC patient who became surgically resectable by downstaging after localized CCRT followed by HAIC. Localized CCRT was performed with a total radiation dose of 4,500 cGy (180 cGy × 25 times) and hepatic arterial infusion of 5-fluorouracil (5-FU, 500 mg/day) via implantable port system during the first and the last weeks of the radiotherapy. Following localized CCRT, the patient was scheduled to receive HAIC with 5-FU (500 mg/m2 for 5 hours, days 1～3) and cisplatin (60 mg/m2 for 2 hours, day 2) every 4 weeks. Marked contraction of HCC was noted on follow up computerized tomography (CT) and positron emission tomography (PET) after localized CCRT and HAIC, and subsequently surgical resection with curative aim was performed. The patient is in complete remission status without recurrence to date.

A Case of Localized Concurrent Chemo-radiation Therapy Using with Tomotherapy for Hilar Hepatocellular Carcinoma with Invasion of Bilateral Bile Duct: Ki Tae Yoon, Do Young Kim, Jin Sil Seong, Jun Yong Park, Jong Won Choi, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon; Journal of the Korean Liver Cancer Study Group. 2008;8(1):102-105. Published online June 30, 2008

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Abstract PDF: Hepatocellular carcinoma (HCC) usually takes an intrahepatic spread via portal vein branches, and the incidence of portal vein invasion is reported to be 34～40% in surgical resected series. On the other hand, the rate of intrabiliary growth of HCC is rare, ranging from 2.3～13% in surgical and autopsy cases. Here, we report a case of the patient treated with localized concurrent chemo-radiation therapy (CCRT) for hilar HCC with invasion of bilateral bile duct. The tomotherapy was performed with a total radiation dose of 4,240 cGy (20 times, 212 cGy/time) on tumor bed and hepatic arterial infusion of 5-fluorouracil (1,000 mg/day, day 1～5 and day 16～20) and cisplatin (60 mg/m2, day 3 and day 18) was done via implantable port system during the radiotherapy. After that, tumor size and tumor marker was decreased and treatment response was achieved as partial response. CCRT is expected as one of the appropriated treatment options for inoperable HCC with bile duct invasion.

A Case of Focal Nodular Hyperplasia-like Nodules in Cirrhosis: Young Joon Yoon, Ki Tae Yoon, Jun Yong Park, Hyun Woong Lee, Hwa Sook Kim, Jae Kyung Kim, Young Nyun Park, Kwang-Hyub Han, Chae Yoon Chon, Young Myung Moon, Mi-Suk Park, Sang Hoon Ahn; Journal of the Korean Liver Cancer Study Group. 2007;7(1):41-44. Published online June 30, 2007

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Abstract PDF: Focal nodular hyperplasia (FNH) usually occurs in non-cirrhotic livers and was defined as a nodule composed of benign appearing hepatocytes occurring in a liver that is otherwise histologically normal or nearly normal. However, due to improvements in imaging techniques and pathological evaluation of explant livers, a focal lesion that is very similar to the classic form of focal nodular hyperplasia that occurs in cirrhotic liver has been described by several reports. Therefore, the term FNH-like nodules has been proposed. In this report, we report a case of focal nodular hyperplasia-like nodules in cirrhosis. A 59 year old woman with known hepatitis B virus infection visited our institution for routine check up. She was diagnosed as having liver cirrhosis and 3.5 cm sized liver mass on abdomen ultrasonography (US). Because tumor marker was negative and US findings are not compatible with hepatocellular carcinoma, other imaging modalities were performed. Magnetic resonance imaging (MRI) documented a 3.5 cm sized hypervascular nodule with internal aberrant vascular structure and multiple small sized nodules in remaining liver. Needle biopsy was targeted to the liver main mass. Microscopic finding revealed FNH-like nodule and underlying liver cirrhosis.

A Case of Advanced Hepatocellular Carcinoma with Inferior Vena Caval Invasion, Resected with a Curative Aim after Concurrent Chemo-Radiation Therapy: Seung Up Kim, Kwang Hyub Han, Jin Sil Sung, Do Young Kim, Sang Hoon Ahn, Gyeong Sig Kim, Young Nyun Park, Chae Yoon Chon; Journal of the Korean Liver Cancer Study Group. 2007;7(1):77-81. Published online June 30, 2007

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Abstract PDF: Hepatocellular carcinoma (HCC) with tumor thrombus in inferior vena cava (IVC) is difficult to treat. Therefore, there are no specific treatment modalities for such case. Here, we present a patient diagnosed as hepatocellular carcinoma with tumor thrombus in inferior vena cava (stage IVa). The patient was treated with concurrent chemo-radiation therapy (CCRT) for 5 weeks. After that, tumor size was markedly decreased, and 9th courses of additional intra-arterial chemotherapy were performed. Follow-up positron emission tomography- computed tomography (PET-CT) showed shrinked hepatocellular carcinoma and right lobe, disappearance of IVC tumor thrombus, decreased size of right hepatic vein thrombus and a faint uptake at gallbladder. Residual malignancy could not be excluded. So, right hepatic lobectomy with a curative aim was performed and its result was successful.

Excellent Response to Hepatic Arterial Infusional Chemotherapy in Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Keun-Ho Lee, Ja Kyung Kim, Kwang-Hyub Han, Jong Tae Lee, Do Youn Lee, Jong Yoon Won, Hyun Woong Lee, Hwa Sook Kim, Ki Tae Yoon, Sang Hoon Ahn, Chae Yoon Chon, Young Myoung Moon; Journal of the Korean Liver Cancer Study Group. 2006;6(1):42-46. Published online June 30, 2006

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Abstract PDF: There is no treatment of curative aim in advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT), which is associated with poor prognosis. Albeit one of the treatment options is intra-arterial infusional chemotherapy, its therapeutic efficacy was minimal. In this report, we present an unusual case of a patient with favorable result after intra-arterial infusional chemotherapy. This patient was HBV carrier and diagnosed having HCC of stage IVb (T4N0M1) with right PVT on February 1999. Direct right adrenal gland and right kidney invasion and numerous intrahepatic metastases were also noted. The serum AFP level showed more than 60,000 ng/mL, and the Child-Pugh score was 5 (class A). The patient received three sessions of intra-arterial 5-fluorouracil (5-FU) and cisplatin combination chemotherapy and two additional sessions of systemic (5-FU) chemotherapy combined with intra-arterial cisplatin infusion. After total 5 sessions of combination chemotherapy, follow-up CT scan revealed grossly total necrosis of main HCC and numerous intrahepatic metastases, without evidence of viable portion in July 1999. The AFP level decreased to 79.4 ng/mL. The latest CT scan taken in November 2005 also showed no evidence of recurrence. It is noteworthy that the patient with advanced HCC with PVT showed complete remission only after 5 sessions of intra-arterial chemotherapy and the status of complete remission is maintained for more than 76 months.

Case of Advanced Hepatocellular Carcinoma (TNM Satge Ⅳa) with Portal Vein Invasion Treated with Intraarterial Chemotherapy and Transarterial Chemoembolization/Chemoinfusion: Chul Kim, Chae Yoon Chon, Jae Yeon Chung, Gun Hoon Song, Young Joon Yun, Tae Ik Chang, Kwang Hyup Han, Young Myoung Moon, Do Yun Lee, Jong Tae Lee; Journal of the Korean Liver Cancer Study Group. 2001;1(1):93-97. Published online June 30, 2001

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Abstract PDF: A 75 year-old-male patient with liver cirrhosis was admitted due to right upper quadrant abdominal pain for 6 months. One month ago, abdominal CT showed a space occupying lesion in the liver. On admission, physical examination revealed mild tenderness on right upper quadrant without jaundice and palpable liver about 3 FB on RLCM. Laboratory findings showed that HBsAg and anti-HCV were negative. AFP was 2,395 ng/ml. Other laboratory findings were within normal range. Abdominal CT showed a huge encapsulated hepatic mass at right lobe of the liver with internal hemorrhage and portal vein thrombosis, which was compatible with advanced hepatocellular carcinoma (stage Ⅳa). Superior mesenteric arteriogram showed right portal vein obstruction. Celiac and hepatic arteriograms revealed huge hypervascular mass at right lobe of the liver. He was treated with intraarterial cisplatin (DDP) infusion. After the 7th intraarterial DDP infusion and the 2nd transarterial chemoembolization (TACE)/transarterial chemoinfusion (TACI), the patient is now without evidence of recurrence for 19 months, and his general condition is good. He is under close observation at out patient clinic.

A Case of Hepatocellular Carcinoma with Right Adrenal Gland Metastasis Treated with Left Lobectomy and Right Adrenalectomy: Young Joon Yoon, Chae Yoon Chon, Chul Kim, Kun Hoon Song, Jae Yeon Jung, Kwang Hyub Han, Young Myung Moon, Do Yun Lee, Jong Tae Lee; Journal of the Korean Liver Cancer Study Group. 2001;1(1):114-117. Published online June 30, 2001

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Abstract PDF: A 42 year-old-female patient with hepatocellular carcinoma was admitted. A year and half ago, she had been diagnosed as having hepatocellular carcinoma(HCC), and treated with transarterial chemoembolization(TACE). Seven months later, Abdomen CT showed recurrence of previously treated HCC and right adrenal gland metastasis. A hepatic angiography demonstrated faint nodule in left lobe of the liver, which was treated with transarterial chemoinfusion(TACI). Right renal angiography demonstrated right adrenal gland mass standing but the embolization was impossible due to narrow vessel caliber. She was treated with total 5,460cGy radiotherapy for right adrenal gland. She was treated with TACI for HCC once more before admission. Total bilirubin was 0.2 mg/dl, AST/ALT, 30/25 IU/L, albumin, 3.8 g/dl, and PT, 100%. AFP was markedly increased to 18,870 ng/ml compared with 6,746 ng/ml at the time of diagnosis. CT demonstrated no interval change of previously treated hepatocellular carcinoma in left lobe of the liver but increased size of right adrenal mass. She was treated with left lobectomy and right adrenalectomy. Postoperative CT demonstrated no evidence of recurrence and AFP was reduced to 257.8 ng/ml. She was then treated with systemic chemotherapy with adriamycin ten times. After the end of treatment, AFP was reduced to 1.64 ng/ml.

An Ischemic Skin Lesion after Chemoembolization of the Right Internal Mammary Artery in a Patient with Hepatocellular Carcinoma: Jae-Hoon Lee, Chae Yoon Chon, Yong-Han Paik, Kwang-Hyub Han, Jong Tae Lee, Do Yun Lee, Young Myoung Moon; Journal of the Korean Liver Cancer Study Group. 2001;1(1):133-136. Published online June 30, 2001

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Abstract PDF: A large nodular hepatocellular carcinoma located at the anterior superior portion of the left lobe was treated with transcatheter arterial chemoembolization through the left hepatic artery. Three months later, however, there was a re-elevation of the serum alpha-fetoprotein level and an evidence of a marginal recurrence at the left side of the previously embolized tumor was noted on the postembolizeation computed tomographic scan. Although the hepatic artery was intact in the second hepatic arteriography, we found that the right internal mammary artery was feeding the recurred hepatocellular carcinoma. Right internal mammary artery was successfully treated with Lipiodol-transcatheter arterial chemoembolization. However, an ischemic lesion occurred in the skin of the anterior chest and abdominal wall several days after the embolization of the internal mammary artery. We report here a very rare case of ischemic skin lesion on the anterior chest and abdominal wall following transcatheter arterial chemoembolization of the right internal mammary artery. This internal mammary artery was embolized because it had developed a collateral tumor feeding vessel following the initial chemoembolization of a hepatocellular carcinoma.