Rapidly progressive hepatocellular carcinoma mimicking benign portal vein thrombosis: a case report

Abstract

Portal vein thrombosis (PVT) is commonly associated with liver cirrhosis, irrespective of the presence of hepatocellular carcinoma (HCC). Given that malignant PVT is a poor prognostic factor in patients with HCC, it is important to differentiate malignant PVT from benign PVT. Because malignant PVT has been reported to be contiguous with parenchymal HCC, in most cases, the presence of PVT alone indicates a benign entity. We report the case of a patient with rapid progression of malignant PVT mimicking benign PVT but without definite parenchymal HCC on imaging modalities.

Keywords: Computed tomography; Disease progression; Hepatocellular carcinoma; Magnetic resonance imaging; Portal vein thrombosis.

Fig. 1

(A) A contrast-enhanced computed tomography (CT) shows portal vein thrombosis (PVT) (black arrow) within the posterior segmental branch of the right portal vein. Focal capsular atrophy was seen in combination with PVT, and there was no enhancement in that area. (B) A T2-weighted image shows PVT (white arrow) with high signal intensity within the posterior segmental branch of the right portal vein. There was no parenchymal tumor surrounding the PVT. (C) A Gadolinium-enhanced T1-weighted image shows mild enhancing PVT (black arrow) with low signal intensity in the posterior segmental branch of the right portal vein. A wedge-shaped enhancement (black arrowheads) is shown in the posterior segment of the right hepatic lobe, which was the result of the secondary-enhanced parenchymal blood supplied by the right hepatic artery due to the decreased portal flow. (D) An ultrasound image shows hypoechoic PVT (white arrow) within the right portal vein of the cirrhotic liver. The 18-gauge cutting needle (white arrowhead) within the malignant PVT is shown during the percutaneous ultrasound-guided biopsy. (E) The needle biopsy sample showed a trabecular arrangement of tumor cells with abundant eosinophilic cytoplasm, suggestive of hepatocellular carcinoma (H&E stain, ×100). (F) A follow-up preoperative contrast-enhanced CT image shows the increased extent of malignant PVT (black arrow) along the left portal vein and the anterior segmental branch of the right portal vein. The more distinct enhancing area (black arrowhead) within the malignant PVT is shown within the more dilated portal vein.