scholarly journals Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome

2018 ◽  
Vol 12 (1) ◽  
pp. 19-26 ◽  
Author(s):  
David F. Pinal-García ◽  
Carlos M. Nuño-Guzmán ◽  
Audrey Gómez-Abarca ◽  
Jorge L. Corona ◽  
Ismael Espejo
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Young Patient ◽  
Spontaneous Rupture ◽  
Liver Tumors ◽  
Transarterial Embolization ◽  
Fatal Outcome ◽  
Noncirrhotic Liver

Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography. Two actively bleeding liver tumors and multiple tumors in a noncirrhotic liver were found. Hemostatic suture and perihepatic packing were performed. The patient remained in critical condition, with a fatal outcome 48 h later. Histopathologic analysis reported HCC and absence of cirrhotic changes. HCC spontaneous rupture incidence is reported between 2.3 and 26%. Median age is 65 years. No liver cirrhosis is found in one-third of patients, with a median age of 51 years. Sudden onset of abdominal pain and shock is observed in the majority of cases. An accurate preoperative diagnosis improves to 75% with ultrasound and computed tomography. Besides hemodynamic stabilization, there is no general agreement on the best treatment option. Transarterial embolization, surgical perihepatic packing, suture plication, and hepatic artery ligation are useful methods of hemostasis in unstable patients. Mortality has been reported from 16.5 to 100%. The histopathologic finding of HCC in a noncirrhotic liver represents a less frequent presentation. A case of spontaneous rupture of HCC carcinoma and a noncirrhotic liver in a young patient is herein reported.

scholarly journals Sorafenib, Risk of Bleeding and Spontaneous Rupture of Hepatocellular Carcinoma. A Clinical Case

2011 ◽  
Vol 54 (4) ◽  
pp. 177-179 ◽  
Author(s):  
Ferdinando Rombolà ◽  
Angelo Caravetta ◽  
Francesco Mollo ◽  
Antonio Spinoso ◽  
Lenino Peluso ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Spontaneous Rupture ◽  
Clinical Case ◽  
Multikinase Inhibitor ◽  
Advanced Hcc ◽  
Risk Of Bleeding ◽  
Good General Condition ◽  
History Of

Spontaneous rupture is a rare and dramatic complication of hepatocellular carcinoma (HCC), burdened by a high mortality. Here we describe a case of a 73-year-old man, who arrived at the ER because of syncope, and acute epigastric and right upper quadrant abdominal pain. He had a history of hepatitis C-related liver cirrhosis and HCC in treatment with sorafenib. The physical examination showed a state of hemorrhagic anemia with the presence of blood in the peritoneal cavity. The patient underwent an urgent liver resection. Thirty days after surgery, he was in good general condition. Sorafenib is a multikinase inhibitor recently introduced in the therapy of patients with advanced HCC. Among the various side effects reported in patients treated with sorafenib, there is a higher risk of bleeding. In conclusion, sorafenib may increase the risk of bleeding and rupture of HCC in susceptible individuals.

scholarly journals Multiple infarcted regenerative nodules in liver, spleen and kidney after gastric and oesophageal bleeding: A case report

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094239
Author(s):  
Anlong Wang ◽  
Yefei Shu
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Differential Diagnosis ◽  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Rare Condition ◽  
Sudden Onset ◽  
Gastric Bleeding ◽  
Regenerative Nodules ◽  
Hepatic Lesions

Infarcted regenerative nodules in a cirrhotic liver is a rare condition that may be confused with hepatocellular carcinoma on imaging. We report here a case of a 58-year-old man with live cirrhosis who presented with abdominal pain and distension and sudden onset of haematemesis. Computed tomography (CT) showed diffuse multinodular infarcted regenerative nodules and gastric bleeding. Physicians should include infarcted regenerative nodules in any differential diagnosis of multiple hepatic lesions in liver cirrhosis, particularly in patients with gastrointestinal varices.

scholarly journals Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Akihito Yamamoto ◽  
Seiryu Kamoi ◽  
Shunji Suzuki
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Renal Vein ◽  
Spontaneous Rupture ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Vascular Network ◽  
Retroperitoneal Hematoma ◽  
Nutcracker Syndrome ◽  
Ovarian Vein

Abstract Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patient

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Essam Mohammed Bayoumi ◽  
Ahmed El Saady Mohamed ◽  
Ahmed El Metwally Ahmed ◽  
Al Saied Al Saied Al Refaey
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Calcium Channel ◽  
Liver Tumors ◽  
Control Group ◽  
Voltage Gated ◽  
Group A ◽  
Cirrhotic Patients ◽  
Voltage Gated Calcium Channel ◽  
Group B

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver tumor and represents the third-leading cause of cancer-related death in the world. The incidence of HCC continues to increase worldwide, with a unique geographic, age, and sex distribution. The most important risk factor associated with HCC is liver cirrhosis, with the majority of cases caused by chronic infection with hepatitis B (HBV) and C (HCV) viruses and alcohol abuse, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary prevention in the form of HBV vaccination has led to a significant decrease in HBV-related HCC, and initiation of antiviral therapy appears to reduce the incidence of HCC in patients with chronic HBV or HCV infection. Additionally, the use of ultrasonography enables the early detection of small liver tumors and forms the backbone of recommended surveillance programs for patients at high risk for the development of HCC. Cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, represent further noninvasive techniques that are increasingly employed to diagnose HCC in patients with cirrhosis. The mainstay of potentially curative therapy includes surgery – either resection or liver transplantation. However, most patients are ineligible for surgery, because of either advanced disease or underlying liver dysfunction, and are managed with locoregional and/or systemic therapies. Randomized controlled trials have demonstrated a survival benefit with both local therapies, either ablation or embolization, and systemic therapy in the form of the multikinase inhibitor sorafenib. Despite this, median survival remains poor and recurrence rates significant. Further advances in our understanding of the molecular pathogenesis of HCC hold promise in improving the diagnosis and treatment of this highly lethal cancer. Objectives Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patients. Patients and Methods This study had been carried out on 90 subjects, age range 21-73 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals. Subjects were divided as follow: Group A(Case): 40 patients with liver cirrhosis without Hepatocellular carcinoma and group B (Control): 40 patients with liver cirrhosis and Hepatocellular carcinoma and group C: 10 normal population for detecting normal value of the marker with exclusion criteria including age < 18 years old and Patients diagnosed with malignancy other than HCC. Results The study subjects are classified into three groups: Group A cirrhotic patients without HCC, Group B cirrhotic patients with HCC and Group C normal individual subjects. Conclusion Serum voltage gated calcium channel levels were significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. Thus it can be used as a tumor marker for HCC.

scholarly journals Reuse of a Pediatric Liver Graft: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Koray Karabulut ◽  
Cengiz Eris ◽  
Turgut Piskin ◽  
Cuneyt Kayaalp ◽  
Sezai Yilmaz
Keyword(s):  
Hepatocellular Carcinoma ◽  
Interventional Radiology ◽  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Brain Death ◽  
Acute Abdominal Pain ◽  
Multiorgan Failure ◽  
Liver Graft ◽  
Liver Donor ◽  
Artery Thrombosis

We report the reuse of a liver graft after brain death of the first recipient. The liver donor was an 8-year-old male who died as a result of head injury. The graft was implanted first to a 4-year-old girl for fulminant hepatic failure. Unfortunately she developed progressive coma and brain death on fifth day of transplantation. The graft functions were normal, and reuse of the liver graft was planned. After informed consent, the graft was transplanted to a 31-year-old female recipient who has hepatocellular carcinoma with an underlying cryptogenic liver cirrhosis. The patient was discharged to home on 9th day after an uneventful postoperative period. However, she was readmitted to hospital with an acute abdominal pain 30 days after the operation. Hepatic artery thrombosis was diagnosed, and the attempt to open the artery by interventional radiology was unsuccessful. She died of sepsis and multiorgan failure on 37th posttransplant day.

scholarly journals Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 739-744
Author(s):  
Nicola Tartaglia ◽  
Alessandra Di Lascia ◽  
Pasquale Cianci ◽  
Alberto Fersini ◽  
Mario Pacilli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Spontaneous Rupture ◽  
Single Case ◽  
Relevant Literature ◽  
Arterial Embolization ◽  
Definitive Treatment ◽  
Prior History ◽  
Preliminary Treatment ◽  
Surgical Department ◽  
Noncirrhotic Liver

AbstractIntroductionHepatocellular carcinoma (HCC) is the sixth most common cancer. Spontaneous rupture of HCC is an acute complication with a high mortality rate. The HCC principally arises in the background of chronic liver disease and cirrhosis of the liver. In the last few years, the rising incidence of HCC in noncirrhotic liver suggests the presence of other factors that may play a role in liver carcinogenesis.MethodsWe reviewed all cases treated at the University Surgical Department of Ospedali Riuniti of Foggia from 2009 to 2018. Only a single case of hemoperitoneum caused by spontaneous rupture of HCC in noncirrhotic liver was found. An extensive search of the relevant literature was carried out using MEDLINE, and a total of 58 published studies were screened from the sources listed.ConclusionsThe management of this devastating emergency should be carefully analyzed, with stabilization of vital signs as soon as possible. Patient with ruptured HCC and hemoperitoneum without a prior history of cirrhosis and viral infections benefited from the role of transcatheter arterial embolization (TAE) as the preliminary treatment in order to have a more precise diagnosis and an optimal stabilization of the patient. Delayed or staged hepatectomy after TAE represents the definitive treatment.

scholarly journals Liver Cirrhosis and Hepatocellular Carcinoma Diagnosed from Chylothorax: A Case Report

2021 ◽  
Vol 11 (3) ◽  
pp. 582-586
Author(s):  
Kenta Ito ◽  
Yoshimasa Hachisu ◽  
Mitsuhiko Shibasaki ◽  
Kazuma Ezawa ◽  
Hiroshi Iwashita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Case Report ◽  
Pleural Effusion ◽  
Malignant Lymphoma ◽  
Review Of The Literature ◽  
Left Pleural Effusion ◽  
History Of

A 71-year-old man visited our hospital with dyspnea and left pleural effusion. Left pleural effusion was diagnosed as chylothorax by thoracentesis. He had no history of trauma or surgery, and there were no findings of malignant lymphoma or thrombosis. Furthermore, he was diagnosed with liver cirrhosis and hepatocellular carcinoma by computed tomography and hematological examinations, and the chylothorax was considered to be caused by liver cirrhosis. We report a review of the literature with this case since it is relatively rare for cirrhosis and hepatocellular carcinoma diagnosed from chylothorax.

Management of Spontaneous Rupture of Hepatocellular Carcinoma: Single-Center Experience

2001 ◽  
Vol 19 (17) ◽  
pp. 3725-3732 ◽  
Author(s):  
Chi-Leung Liu ◽  
Sheung-Tat Fan ◽  
Chung-Mau Lo ◽  
Wai-Kuen Tso ◽  
Ronnie Tung-Ping Poon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Spontaneous Rupture ◽  
Therapeutic Approach ◽  
Transarterial Embolization ◽  
Definitive Treatment ◽  
Serum Total Bilirubin ◽  
Single Center ◽  
Two Stage ◽  
Second Stage

PURPOSE: To report the management of patients with spontaneous rupture of hepatocellular carcinoma (HCC) in a single center over a 10-year period and to evaluate a two-stage therapeutic approach. PATIENTS AND METHODS: A retrospective study was performed on all 1,716 patients with HCC who presented from 1989 to 1998. The two-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means, followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Results of definitive treatment were compared with patients with no history of rupture during the same study period. RESULTS: During the study period, 154 patients (9%) had spontaneous HCC rupture. Initial intervention to control bleeding included TAE in 42 patients, surgical hemostasis in 35 patients, and conservative management only in 53 patients. The 30-day mortality rate was 38%. Independent factors on presentation affecting 30-day mortality were shock on admission, hemoglobin, serum total bilirubin, and known diagnosis of inoperable tumor. After initial stabilization and clinical evaluation, 33 patients underwent hepatic resection and 30 patients received TOCE. Median survival of the hepatectomy patients was 25.7 months; that of the TOCE patients was 9.7 months. Compared with patients with no rupture, survival after hepatectomy (25.7 months v 49.2 months, P = .003) was inferior but still substantially long, whereas survival after TOCE was comparable (9.7 months v 8.7 months, P = .904). CONCLUSION: Early mortality of spontaneous rupture of HCC was dependent on prerupture disease state, liver function, and severity of bleeding. Although it was a catastrophic presentation, prolonged survival could be achieved in selected patients with second-stage hepatic resection or TOCE.

Pattern Analysis of Serum alpha-fetoprotein in the Early Diagnosis of Hepatocellular Carcinoma in Liver Cirrhosis

1988 ◽  
Vol 3 (3) ◽  
pp. 172-176 ◽  
Author(s):  
A. Arrigoni ◽  
A. Andriulli ◽  
T. Gindro ◽  
P. Piantino ◽  
L. Capussotti ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Liver Tumors ◽  
Alpha Fetoprotein ◽  
Cutoff Point ◽  
Surveillance Program ◽  
Unique Role ◽  
Early Expression ◽  
Serum Alpha Fetoprotein

In a surveillance program for hepatocellular carcinoma (HCC), serum alpha-fetoprotein (AFP) was determined every 4 months in 164 patients with liver cirrhosis. Ultrasonography (US) was performed yearly or as dictated by abnormal AFP levels. During a follow-up of 32.5 ± 20.8 months HCC was identified by US in 16 patients. In 9 of them the AFP levels rose steadily over 4 months, increasing 7, 8 and 12 months in 3 cases before the lesion became detectable by US. In 4 patients tumors developed despite persistently normal AFP levels. Nine more patients showed abnormal fluctuations of AFP but HCC was not detected. AFP sensitivity was higher at a low cutoff point (40 ng/ml) while specificity of the test appeared higher at the 200 ng/ml cutoff point. An AFP value rising steeply over a few months appeared more reliable than a fixed preset threshold in indicating carcinomatous transformation. Screening for AFP can be expected to uncover about 3/4 of HCC developing in cirrhotics with few false-positive reactions. The test may have a unique role in identifying a subset of liver tumors whose early expression is AFP production.

Sign in / Sign up

Export Citation Format

Share Document