Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization

Abstract

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.

Keywords: Hepatocellular carcinoma; Spontaneous rupture; Transarterial chemoembolization.

Figure 1

Initial abdominal computed tomography findings. A large hepatic mass was identified at segment 8. The focal hypo-attenuated lesion on the surface of the mass (arrow) and the fluid collection in the pelvic cavity (arrowhead) indicated a relatively recent tumor rupture.

Figure 2

Magnetic resonance imaging findings. A single 12 cm wide hepatocellular carcinoma lesion at segment 8 without vascular invasion was identified with enhancement in the arterial phase (A), and washout in the portal phase (B) and delayed phase (C).

Figure 3

Angiogram of the first transarterial chemoembolization (TACE) showed a single massive tumor staining (A). After the first TACE, residual tumor (arrow) was found on the magnetic resonance imaging (B), and secondary TACE was performed 5 months later. Peripheral tumor staining (arrow) was identified at angiography of the secondary TACE (C). After secondary TACE, the treated mass without residual tumor was noted on the liver computed tomography scan (D).

Figure 4

The exterior (A) and interior (B) of the segment 7/8 tumor resected by right hemihepatectomy. The single yellow mass proved to be complete necrosis with no cancer cells.