title: Inferior vena cava tumor thrombus that directly infiltrated from paracaval lymph node metastases in a patient with recurrent hepatocellular carcinoma.
abstract: Herein, we present the case of a patient with recurrent hepatocellular carcinoma (HCC) who had paracaval lymph node (LN) metastases with an inferior vena cava (IVC) tumor thrombus after a hepatectomy. A 65-year-old man with chronic hepatitis B virus infection received an extended anterior segmentectomy because of two hepatic tumors, located in segments 7 and 8. Histological examination of both resected specimens showed mostly moderately differentiated HCC with some poorly differentiated areas, and liver cirrhosis (A2/F4). Because the patient had an elevated α-fetoprotein serum level, abdominal computed tomography (CT) was performed. Abdominal CT revealed a 9-mm-diameter recurrent tumor in hepatic segment 3 and paracaval LN metastases with an IVC tumor thrombus at 8 months after the first operation. The patient received transcatheter arterial chemoembolization as treatment for the intrahepatic recurrence, following resection of the paracaval LN metastases and removal of the IVC tumor thrombus. In this case, the paracaval LN metastases had directly infiltrated the IVC via the lumbar veins, resulting in an IVC tumor thrombus, which usually develops from an intrahepatic tumor via the hepatic vein. The development of an IVC tumor thrombus with HCC recurrence, as in this case, is very rare, and based on a PubMed search, we believe this report may be the first to describe this condition.
authors.forename: Shinya
authors.initials: S
authors.lastname: Imada
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishiyama
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ide
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D013927:Thrombosis / Q000209:etiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology*
references.citation: N Engl J Med. 2008 Jul 24;359(4):378-90
references.pmid: 18650514
references.citation: J Hepatobiliary Pancreat Sci. 2011 Jul;18(4):559-66
references.pmid: 21331804
references.citation: Hepatogastroenterology. 1990 Apr;37(2):188-93
references.pmid: 2160421
references.citation: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1067-76
references.pmid: 15913915
references.citation: J Gastroenterol Hepatol. 1990 Jan-Feb;5(1):82-93
references.pmid: 2103385
references.citation: Hepatogastroenterology. 2009 Mar-Apr;56(90):476-80
references.pmid: 19579624
references.citation: World J Gastroenterol. 2011 May 7;17(17):2255-8
references.pmid: 21633538
references.citation: Radiology. 1998 Jan;206(1):161-6
references.pmid: 9423667
references.citation: J Clin Oncol. 2013 May 1;31(13):1631-9
references.pmid: 23547075
references.citation: Acta Med Okayama. 2012;66(2):177-82
references.pmid: 22525476
references.citation: Surg Today. 2000;30(10):892-5
references.pmid: 11059728
references.citation: Asian J Surg. 2011 Apr;34(2):53-62
references.pmid: 21723467
references.citation: Hepatology. 2011 Mar;53(3):1020-2
references.pmid: 21374666
references.citation: Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):362-8
references.pmid: 22381903
references.citation: Radiology. 2000 Sep;216(3):698-703
references.pmid: 10966697
references.citation: J Surg Oncol. 2007 Jul 1;96(1):37-45
references.pmid: 17345597
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001199
references.pmid: 19160192
references.citation: J Gastroenterol Hepatol. 2003 Mar;18(3):345-9
references.pmid: 12603540
references.citation: Korean J Hepatol. 2007 Sep;13(3):387-95
references.pmid: 17898555
references.citation: Hepatology. 2008 Jan;47(1):82-9
references.pmid: 18008357
references.citation: Jpn J Clin Oncol. 1994 Feb;24(1):37-41
references.pmid: 8126919