title: Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma.
abstract: A 57-year-old man, who had undergone hepatic arterial infusion chemotherapy with right portal occlusion for hepatocellular carcinoma was admitted to our hospital because of severe abdominal pain. Contrast-enhanced computed tomograms revealed that most areas of the liver were not enhanced, a finding suspicious for perfusion disturbance in the liver. Angiography revealed an interrupted right hepatic artery. Arterial portograms revealed complete obstruction of the right portal vein and a small left branch of the portal vein. Despite anticoagulant therapy with urokinase for portal vein thrombosis, the patient died from hepatorenal failure. Autopsy revealed that cholangiocarcinoma occupied almost the entire parenchyma of the right lobe, although the treated hepatocellular carcinoma lesion was completely necrotic. The right hepatic artery was obstructed due to direct invasion of tumor. There were diffuse thrombi in the left portal branches surrounded by tumor infiltrating along Glisson's sheath to the peripheral portion of the left lobe.
authors.affiliation: Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. m6877710@msic.med.osaka-cu.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Haba
authors.forename: Kenichi
authors.initials: K
authors.lastname: Wakasa
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy; D018281:Cholangiocarcinoma / Q000150:complications* / Q000473:pathology; D017809:Fatal Outcome; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000150:complications; D011169:Portal Vein / Q000473:pathology; D020246:Venous Thrombosis / Q000209:etiology* / Q000473:pathology