title: Successful use of sirolimus in a patient with bulky ovarian metastasis of hepatocellular carcinoma after liver transplantation.
abstract: This 44-year-old woman developed multifocal hepatocellular carcinoma (HCC) within hepatitis B-induced liver cirrhosis. At the time of listing for transplantation the HCC had progressed beyond the Milan criteria. Due to her young age, high grade of histological differentiation according to biopsy, and lack of therapeutic alternatives, she was listed for transplantation. She received an organ from the Eurotransplant marginal liver list. Immunosuppression was reduced to tacrolimus monotherapy within 4 months. Five months after transplantation bilateral bulky ovarian metastases were seen on computed tomography (CT) scan. A bilateral salphingo-oophorectomy was performed and immunosuppression switched to sirolimus monotherapy. Fourteen months after this procedure and 19 months after transplantation, the patient is asymptomatic with stable liver function. She is free of recurrence as judged by CT scan, bone scan, and alpha-fetoprotein. In conclusion, radical surgical treatment and immunosuppression using sirolimus may achieve tumor-free survival in selected patients with advanced or recurrent HCC.
authors.affiliation: Department of Visceral and Vascular Surgery, University of Cologne, Joseph Stelzmann Strasse 9, 50931 Köln, Germany. dirk.stippel@uni-koeln.de
authors.forename: D L
authors.initials: DL
authors.lastname: Stippel
authors.forename: H U
authors.initials: HU
authors.lastname: Kasper
authors.forename: K
authors.initials: K
authors.lastname: Schleimer
authors.forename: U
authors.initials: U
authors.lastname: Töx
authors.forename: C
authors.initials: C
authors.lastname: Bangard
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: K T E
authors.initials: KT
authors.lastname: Beckurts
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D011859:Radiography; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D007166:Immunosuppressive Agents; D020123:Sirolimus