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Case Reports
. 2024 Feb 28;16(2):e55158.
doi: 10.7759/cureus.55158. eCollection 2024 Feb.

Tumor Thrombus of Hepatocellular Carcinoma: A Direct Extension From the Liver to the Right Atrium

Moutaz Ghrewati  1 , Anas Mahmoud  2 , Tala Beilani  1 , Sean A Keegan  3 , Mehandar Kumar  1
Affiliations
Case Reports

Tumor Thrombus of Hepatocellular Carcinoma: A Direct Extension From the Liver to the Right Atrium

Moutaz Ghrewati et al. Cureus. .

Abstract

Hepatocellular carcinoma (HCC) is a very aggressive type of cancer and can either invade or spread distantly through the portal vein to the inferior vena cava (IVC) and the right atrium (RA). The presentation varies based on the stage of the cancer at the time of diagnosis. Liver transplantation or surgical resection is the ideal management of small lesions without metastases, while systemic therapy can help in extensive cases to decrease the tumor burden to allow surgical resection of the tumor. We present a rare case of HCC with a tumor thrombus (TT) extending to the RA. Unfortunately, the patient did not survive the cancer. We hope that this case report can contribute to saving the lives of future patients with HCC.

Keywords: hepatocellular carcinoma (hcc); ivc thrombus; milan criteria; radio-embolization; right atrium tumor thrombus.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The CT of the abdomen with contrast
Seen is a very large heterogeneously enhancing mass centered in the right hepatic lobe, measuring 18.3 cm x 11 cm (blue arrow).
Figure 2
Figure 2. Triple-phase CT with liver mass protocol (arterial phase)
The enhanced mass is seen with an enhancing capsule around it, compared to the rest of the liver tissue. This is because the mass is getting blood supply from the hepatic artery (early enhancement), while the rest of the liver is receiving it from the portal vein.
Figure 3
Figure 3. Triple-phase CT with liver mass protocol (venous phase)
A decreased enhancement of the capsule around the mass (red arrow) is seen with a further low enhancement of the mass (yellow arrow) as the rest of the liver is receiving blood supply containing the contrast from the portal vein.
Figure 4
Figure 4. Triple-phase CT with liver mass protocol (delayed phase)
Seen is a wash of the enhancement of the mass and the capsule around the mass (red arrow) and further hypodensity of the mass (yellow arrow). This is evident as the rest of the liver is getting more blood supply containing the contrast from the portal vein compared to the mass, which is receiving its supply from the hepatic artery.
Figure 5
Figure 5. Sagittal view of the repeat CT of chest and abdomen with contrast
Seen is the extension of the tumor to the IVC and the RA (yellow arrow). IVC: Inferior vena cava, RA: Right atrium
Figure 6
Figure 6. Coronal view of the repeat CT chest and abdomen with contrast
Displayed is the extension of the tumor to the IVC and the RA (yellow arrow). IVC: Inferior vena cava, RA: Right atrium
See this image and copyright information in PMC

References

    1. Hepatocellular carcinoma (HCC): epidemiology, etiology, and molecular classification . Chidambaranathan-Reghupaty S, Fisher PB. Adv Cancer Res. 2020 - PMC - PubMed
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    1. Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus. Xia Y, Zhang J, Ni X. Oncol Lett. 2020;20:101. - PMC - PubMed
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    1. Detection of tumor thrombus in hepatocellular carcinoma. Morrell GR. Radiology. 2022;302:116–117. - PubMed

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