対側門脈枝内へ進展浸潤した肝細胞癌の１例

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  • A case of hepatocellular carcinoma progressed to the contralateral portal vein.

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A 54-year-old woman complaing of right upper abdominal pain was referred to the hospital with a diagnosis of a giant hepatocellular carcinoma (HCC) 20cm in size on admission, the HCC occupied the entire right and medial lobes of the liver, and contacted with the left hepatic vein. The tumor emboli advanced to the main to left branchs of portal vein (Vp4). A right trisegmentectomy, a caudate lobectomy, a removal of the tumor emboli in the portal vein, a bile duct resection and a hepaticojejunostomy were performed. During the removal of the tumor emboli, a baloon catheter inserted from the umbilical vein was used as a method of hemostasis. The postoperative course was uneventful and she was discharged from the hospital on 24th POD. However, recurrence occurred in the remnant liver two months later. Inspite of additional therapies such as intermittent, intraarterial chemotherapy with reservor and radiation, she died of recurrence ten months after the operation. Pathologically, the mass was moderately differentiated HCC with vp4 and the tumor emboli invaded the wall of the bifurcation of the portal vein. We think that this HCC revealed a rare mode of progression as HCC.

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