A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.
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Multiple lenvatinibāassociated skin ulcers: A case report and literature review Soo Hyun Jeon, Woo Jin Lee, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee, Joon Min Jung Australasian Journal of Dermatology.2023;[Epub] CrossRef
In patients with advanced hepatocellular carcinoma (HCC), tumor thrombus in inferior vena cava (IVC) and right atrium (RA)
are not uncommon findings and are usually associated with extremely poor outcome. Although aggressive surgical interventions
such as extracorporeal circulation and tumor excision have been performed, the reported results were still unsatisfactory. Herein,
we report the favorable result of combined treatment with radiation therapy and transarterial chemoembolization in a patient with
advanced HCC with extensive tumor thrombus through the IVC into the RA. In conclusion, noninvasive combined modalities,
such as transarterial chemoembolization and radiation therapy may sometimes provide effective palliation for patients with far
advanced HCC with IVC/RA tumor thrombus and who are not candidates for alternative treatment options.
Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of
hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications
and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads
loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to
conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after
the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive
treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver
cirrhosis patient who was not eligible for conventional TACE treatment.
Seung Young Kim, Hyung Joon Yim, Jae Hong Ahn, Sung Woo Jung, Jeong Han Kim, Ji Hoon Kim, Ju-Han Lee, Seung Hwa Lee, Hwan Hoon Chung, jong Eun Yeon, Hong Sik Lee, Sang Woo Lee, Kwan Soo Byun, Jai Hyun Choi
Journal of the Korean Liver Cancer Study Group. 2009;9(1):86-89. Published online June 30, 2009
Helatocellular carcinoma (HCC) is uncommon in young adults, and young HCC patients is known to show poor prognosis
than older HCC patients because they have a more advanced tumor stage at diagnosis. We describe a case of HCC in a
28-year old chronic hepatitis B virus carrier who showed multiple nodular HCC with bone metastasis at diagnosis. In spite
of multidisciplinary treatment including transarterial chemoembolization (TACE) for liver mass and radiotherapy for metastatic
bone lesion, the patient died of cancer progression and weakened general condition 15 months after diagnosis. Therefore, we
need to consider periodic surveillance in young chronic hepatitis B virus carriers.