title: Tumoral pulmonary emboli from angioinvasive hepatocellular carcinoma.
abstract: Tumoral pulmonary emboli from hepatocellular carcinoma (HCC) have rarely been described, although invasion of the portal and hepatic venous systems is a well-known complication. HCC originating in a noncirrhotic liver in the absence of chronic hepatitis B infection is also uncommon. We present a case of a patient with chronic hepatitis C infection without hepatic cirrhosis who developed angioinvasive HCC with intracardiac extension and tumoral pulmonary emboli. Differential considerations, including combined HCC-cholangiocarcinoma, other hepatic mesenchymal tumors, and metastasis, are discussed. Owing to poor prognosis, no resection was attempted. Autopsy was performed because of the unusual clinical presentation, and immunohistochemistry of the hepatic tumor, the intracardiac extension, and the pulmonary emboli were concordant with hepatocellular origin. Even though definitive diagnosis may not affect patient outcome, it is important for radiologists and clinicians to be aware that angioinvasive HCC may arise in the absence of cirrhosis.
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA. Electronic address: tjclark@uw.edu.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Clark
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Maximin
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Jabi
authors.initials: J
authors.lastname: Shriki
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Bhargava
mesh_terms: D000368:Aged; D001344:Autopsy; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology*; D017809:Fatal Outcome; D019698:Hepatitis C, Chronic / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000401:mortality / Q000473:pathology*; D014057:Tomography, X-Ray Computed