Isolated metastasis of hepatocellular carcinoma in the right ventricle: A case report

Abstract

Metastatic hepatocellular carcinoma (HCC) of the right ventricle is very rare and difficult to diagnosis.A 79-year-old man who underwent right hemi-hepatectomy for HCC was admitted to our hospital for chest pain, severe dyspnea, and orthopnea. The echocardiogram showed a tumor located in the right ventricle. A biopsy was obtained, and histopathological findings confirmed metastatic HCC. Palliative resection of the tumor was performed.There is no standard treatment for metastatic HCC into the right ventricle. Thus, treatment should be individualized to the patient, and a multidisciplinary approach should be used.

Figure 1

Transthoracic echocardiogram of the tumor (4.97 cm × 3.22 cm).

Figure 2

Contrast-enhanced computed tomography scans (axial view). A multilobulated, polypoid, isodense to hypodense, soft tissue mass was found in the right ventricular chamber.

Figure 3

Cardiac magnetic resonance images using the black-blood and fat subtraction technique. The right ventricular mass with a multilobulated surface was an isointensity lesion on the T1-weighted image and a slightly high intensity lesion on the T2-weighted image ([A] arrows indicate the isointensity; [B] arrowheads indicate the high intensity area).

Figure 4

Positron emission tomography–computed tomography image. The arrow indicates the thickened right ventricular free wall with abnormal uptake of 18-fluoro-2-deoxyglucose (standardized uptake value, 5.5). RA = right atrium.

Figure 5

Positron emission tomography–computed tomography images. There was no abnormal uptake of 18-fluoro-2-deoxyglucose in the liver.

Figure 6

Results of the hepatocyte antigen immunohistochemistry analysis. The immunochemical finding from hepatocyte antigen immunohistochemistry analysis is specific for the neoplastic or nonneoplastic hepatocyte antigen. A special stain was performed with immunohistochemistry (3,3′-diaminobenzidine, ×200).

Figure 7

Photographs showing the palliative mass resection. (A) A huge mass was found during right atriotomy. (B) The gross specimen showing a yellowish, dark purple polypoid mass.

Figure 8

Three-phase abdominal computed tomography images. The arrows indicate multifocal arterial enhanced lesions suggestive of a new hepatocellular carcinoma in the left hepatic lobe.