title: A case of rapid intrahepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is a novel technique for the treatment of liver malignancies that is becoming increasingly more popular because of its feasibility, effectivity, repeatability, and safety. However, an increased number of complications after RFA has been reported in literature. The aim of this paper is to discuss the possible role of RFA in rapid intrahepatic spreading of hepatocellular carcinoma (HCC).
  
  
  METHODS
  We treated a 66-year-old woman who had a 3.5-cm HCC with two courses of percutaneous RFA using a modified needle with seven hooks. The effectiveness of the treatment was assessed 1 month later by enhanced computed tomography.
  
  
  RESULTS
  Two courses of treatment were needed owing to the nodule position (close to the inferior vena cava). Computed tomography scan performed 1 month after the second RFA showed an intrahepatic arteriovenous fistula. Angiography performed after 1 month showed a rapid intrahepatic spreading of HCC.
  
  
  CONCLUSIONS
  Radiofrequency ablation can create an arteriovenous fistula that can facilitate migration of tumoral cells from the nodule to the hepatic portal system and rapid intrahepatic dissemination of HCC.
authors.affiliation: Department of Surgery, Azienda Ospedaliera V. Cervello, Palermo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Casaril
authors.forename: Moh'd
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Gerardo
authors.initials: G
authors.lastname: Mangiante
authors.forename: Luigi
authors.initials: L
authors.lastname: Marchiori
authors.forename: Michele
authors.initials: M
authors.lastname: Ciola
authors.forename: Laura
authors.initials: L
authors.lastname: Invernizzi
authors.forename: Tommaso
authors.initials: T
authors.lastname: Campagnaro
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Mansueto
mesh_terms: D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016461:Chemoembolization, Therapeutic; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D009366:Neoplasm Seeding; D011169:Portal Vein