EL Bacha et al. Journal of Medical Case Reports (2017) 11:7 DOI 10.1186/s13256-016-1160-8
CASE REPORT
Open Access
Complete necrosis of hepatocellular carcinoma after preoperative portal vein embolization: a case report H EL Bacha1,2*, M Salihoun1,2, N Kabbaj1,2 and A Benkabbou1,3
Abstract Background: Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations for more patients outside these guidelines. Our case shows a patient with intermediate stage hepatocellular carcinoma presenting a good outcome after curative treatment. Case presentation: We report the case of an 80-year-old Moroccan man, who was positive for hepatitis c virus, presenting an intermediate stage hepatocellular carcinoma (three lesions between 20 and 60 mm). He presented a complete tumor necrosis after portal vein embolization and achieved 24-month disease-free survival after surgery. Conclusions: Perioperative care in liver surgery and multidisciplinary discussion can help to extend indications for liver resection for hepatocellular carcinoma outside European Association for the Study of the Liver/American Association for the Study of Liver Diseases recommendations and offer a curative approach to selected patients with intermediate and advanced stage hepatocellular carcinoma. Keywords: Hepatocellular carcinoma, Portal vein embolization, Liver resection, Complete tumor necrosis
Background Less than one out of three patients diagnosed with hepatocellular carcinoma (HCC) may undergo a curative treatment: liver resection, liver transplantation, or percutaneous ablation [1]. Refinement of surgical techniques and perioperative care helped to extend indications for liver resection for HCC outside European Association for the Study of the Liver (EASL)/American Association for the Study of Liver Diseases (AASLD) recommendations with encouraging short-term and long-term outcomes [2]. When a liver resection of more than three segments is considered, preoperative portal vein embolization (PVE) is of critical importance because it induce a significant growth of the remnant liver, and prevent a potentially lethal postoperative liver failure [3]. Because of a main arterial supply, HCC may respond to * Correspondence:
[email protected] 1 Faculté de médecine et de pharmacie de Rabat, Mohammed V University, Rabat, Morocco 2 Explorations Fonctionnelles Digestives, Ibn Sina Hospital, Rabat, Morocco Full list of author information is available at the end of the article
transarterial embolization or transarterial chemoembolization (TACE) but not PVE. We report a case of a complete histological necrosis of a HCC after preoperative right PVE.
Case presentation An 80-year-old Moroccan man presented with a 4-month history of nonspecific abdominal pain and asthenia, he had no comorbidity except late onset asthma. His performance status was good (PS 0 to 1) and a physical examination unremarkable. Abdominal imaging (ultrasound and contrast-enhanced computed tomography) showed three liver lesions of 20 mm (liver segment 7), 27 mm (liver segment 5), and 60 mm (liver segment 6). None of the three lesions fulfilled imaging diagnosis criteria for HCC (Fig. 1; poor arterial enhancement). His spleen size was normal and there was no sign of portal hypertension. Laboratory tests found a slight cytolysis of 1.4-fold normal value. His serum dosage of bilirubin and albumin, and prothrombin time were normal. His serum
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EL Bacha et al. Journal of Medical Case Reports (2017) 11:7
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Fig. 1 Enhanced computed tomography images showing three liver lesions of 20 mm (liver segment 7), 27 mm (liver segment 5), and 60 mm (liver segment 6)
alpha-fetoprotein (AFP) value was 341.40 ng/ml (normal value
