Journal of Liver Cancer

Case Reports

Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization: Ji Eun Lee, Joong-Won Park, In Joon Lee, Bo Hyun Kim, Seoung Hoon Kim, Hyun Beom Kim; J Liver Cancer. 2020;20(2):154-159. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.154

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Abstract PDF: Spontaneous tumor rupture is a serious but rare complication of hepatocellular carcinoma (HCC) and has a low survival rate. Here, we report a case of massive HCC that ruptured and was treated successfully with transarterial chemoembolization (TACE). A 55-year-old man with abdominal pain was diagnosed with a 12-cm-wide ruptured HCC at segment 8. The overall liver function was scored as Child–Pugh A, but the single nodule tumor had ruptured; therefore, TACE treatment was initiated. After the first TACE treatment, residual tumors were found; thus, secondary TACE was performed 5 months later. No new lesions or extrahepatic metastases were found 16 months after the first TACE treatment, so hepatic resection was performed for curative treatment. The postoperative pathology results did not reveal any cancer cells; hence, TACE alone resulted in a cure. We report this case because the cure has been maintained for more than 3 years after resection.

A Case of Spontaneous Rupture of Hepatocellular Carcinoma Supplied by the Right Renal Capsular Artery Treated by Transcatheter Arterial Embolization: Joo Yeon Jang, Ung Bae Jeon, Jin Hyeok Kim, Tae Un Kim, Hwaseong Ryu, Mong Cho, Young Mi Hong, Maeran Kim; J Liver Cancer. 2019;19(1):59-63. Published online March 31, 2019; DOI: https://doi.org/10.17998/jlc.19.1.59

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Abstract PDF: We present a case of spontaneous rupture of hepatocellular carcinoma with poor liver function managed by transcatheter arterial embolization (TAE). The patient’s bilirubin level was 2.1 mg/dL, albumin level was 2.4 g/dL, and prothrombin time international normalized ratio was 2.1. In addition, the patient had also developed a large number of ascites. The tumor was supplied by the right renal capsular artery, as observed on angiography. With successful TAE, no hepatic failure occurred. We believe TAE can be a safe and effective treatment option, even in patients with poor liver function, if tumors are supplied only by extrahepatic collateral vessels.

Original Article

Outcomes of Surgical Resection for Ruptured Hepatocellular Carcinoma: Hae Won Lee, Chang-Sup Lim, Hyo-Sin Kim; J Liver Cancer. 2017;17(1):54-59. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.54

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Abstract PDF

Background/Aims
Many recent studies have shown excellent outcomes of surgical resection for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after surgical resection. However, the impact of HCC rupture on recurrence and patient survival has not yet been clarified.
Methods
The medical data of patients who underwent surgical resection for ruptured HCC in our center between January 2011 and December 2015 were retrospectively reviewed. The outcomes of the patients were investigated.
Results
Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial chemoembolization (TACE) was performed for achieving hemostasis in four patients except one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one patient died due to HCC recurrence during the median follow-up duration of 28.3 months (range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0 months after resection was managed well by means of radiofrequency ablation and TACE and is now alive for 5 years without any evidence of viable tumor. However, the other patient who showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive treatments.
Conclusions
Rupture of HCC might result in peritoneal seeding of the tumor in the early postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be the best treatment option yielding good survival, even for a ruptured HCC.

Citations

Citations to this article as recorded by

Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization
Ji Eun Lee, Joong-Won Park, In Joon Lee, Bo Hyun Kim, Seoung Hoon Kim, Hyun Beom Kim
Journal of Liver Cancer.2020; 20(2): 154. CrossRef

Review Article

Emergencies in Patients with Hepatocellular Carcinoma: Chang Wook Kim, Chang Don Lee; Journal of the Korean Liver Cancer Study Group. 2013;13(1):1-7. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.1

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Abstract PDF: Patients with hepatocellular carcinoma (HCC) may be suffered by various emergency conditions such as spontaneous rupture of HCC with intraperitoneal hemorrhage, variceal bleeding with portal vein tumor thrombus, hemobilia, obstructive jaundice, distant metastasis of HCC in central nervous system, spinal bone metastasis of HCC with cord compression and so on. These emergencies can be categorized into 4 types, conditions with spontaneous rupture of HCC, distant metastasis of HCC, direct invasion of HCC and paraneoplastic syndrome. According to HCC status and liver function, some these patients showed more beneficial effects with active palliative treatments than with best supportive cares. Various palliative treatments can be used such as surgical resection, transarterial chemoembolization, radiotherapy, systemic chemotherapy and combination of above therapies. We reviewed the emergencies in patients with HCC for improving survival and quality of life.

Case Report

A Case of Early and Massive Recurred Hepatocellular Carcinoma in Patients with Ruptured Hepatocellular Carcinoma Underwent Staged-Surgical Resection: Sung Hoon Kim, Jin Hong Lim, Sang Hoon Ahn, Kyung Sik Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(2):155-159. Published online September 30, 2011

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Abstract PDF: The rupture of hepatocellular carcinoma (HCC) has been uncommon complication. Because the diagnosis of early HCC has been increase due to development of imaging modality and surveillance program, the incidence of ruptured HCC has been decreased. The paradigm of treatment for ruptured HCC has shifted from surgical hemostasis to transcatheteric chemoembolization (TACE) at acute phase. After the control of acute phase, the definitive treatment for HCC is still debate. However, many studies have advocated staged-liver resection. Some studies reported that the patients underwent staged-liver resection showed a similar survival rate compared with survival rate in patient with non-ruptured HCC. The staged-liver resection was usually performed in the patients with well-preserved liver function. The decision of optimal time for surgery after TACE and surgical indications for ruptured HCC after any other primary treatment are controversy. We experienced a cases of early and massive recurrence HCC in patients with well-preserved liver function and the rupture of HCC. The further study may be needed to decide the optimal time of surgery after TACE and surgical indication for rutprued-HCC.

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