title: Complete pathological response to transcatheter arterial infusion despite a rapidly progressing recurrent hepatocellular carcinoma with portal vein tumor thrombus: A case report.
abstract: BACKGROUND
  We report a patient with a rapidly progressing recurrence of hepatocellular carcinoma (HCC) with a portal vein tumor thrombus after radiofrequency ablation of the original lesion, then treated with transcatheter arterial infusion. Radical hepatic resection demonstrated a complete pathological response.
  
  
  METHODS
  A 60-year old male with alcoholic cirrhosis and gastric varices was diagnosed with HCC measuring 12mm in segment 8. He underwent laparoscopic radiofrequency ablation, but recurred three months later. The lesion progressed rapidly and the right portal vein was occluded. He then underwent transcatheter arterial infusion with miriplatin and iodized oil, which was effective in reducing the size of the main lesion and portal vein tumor thrombus. Right anterior sectionectomy was then performed. Pathologically, there were no viable HCC cells in either the main lesion or the portal vein thrombus. He is alive two years and nine months after surgery without recurrence.
  
  
  CONCLUSIONS
  A rapidly progressing HCC recurrence with portal vein tumor thrombus is usually associated with a poor prognosis. No effective treatments have been reported in this situation except hepatic resection. In this patient the tumor was effectively reduced after three courses of transarterial miriplatin and subsequent radical hepatic resection. This is the first report to achieve a complete pathological response for such an aggressive recurrence after initial radiofrequency ablation.
  
  
  CONCLUSIONS
  This strategy may result in long-term survival of patients with rapidly progressing recurrent HCC with portal vein thrombus, and further study is warranted.
authors: Department of Surgery, Jichi Medical University, Japan. Electronic address: tcvtag@jichi.ac.jp.
authors: Masanobu
authors: M
authors: Taguchi
authors: Department of Surgery, Jichi Medical University, Japan.
authors: Yasunaru
authors: Y
authors: Sakuma
authors: Department of Surgery, Jichi Medical University, Japan.
authors: Hideki
authors: H
authors: Sasanuma
authors: Department of Surgery, Jichi Medical University, Japan.
authors: Naohiro
authors: N
authors: Sata
authors: Department of Surgery, Jichi Medical University, Japan.
authors: Alan Kawarai
authors: AK
authors: Lefor
authors: Department of Radiology, Jichi Medical University, Japan.
authors: Takahiro
authors: T
authors: Sasaki
authors: Department of Pathology, Jichi Medical University, Japan.
authors: Akira
authors: A
authors: Tanaka
authors: Department of Surgery, Jichi Medical University, Japan.
authors: Yoshikazu
authors: Y
authors: Yasuda
keywords: Complete pathological response; Hepatocellular carcinoma; Portal tumor thrombus; Radiofrequency ablation; Rapidly progressive recurrence; Transcatheter arterial infusion