title: Long-term surviving patient with inferior vena cava tumor thrombus and extrahepatic metastasis after spontaneous ruptured hepatocellular carcinoma.
abstract: We present a case of long-term survival in a patient with inferior vena cava tumor thrombus (IVCTT) and extrahepatic metastasis after resection for spontaneous ruptured hepatocellular carcinoma (HCC). The patient was a 73-year-old Japanese man previously diagnosed with chronic hepatitis B. He was referred to our emergency room and diagnosed with spontaneous ruptured HCC. The patient was immediately treated with transcatheter arterial embolization, and we then performed second-stage hepatic resection 50 days later. Although des-gamma-carboxy prothrombin was reduced to a normal level after hepatectomy, it gradually increased and computed tomography showed a disseminated tumor in the diaphragm near S2 of the liver with IVCTT and right atrium tumor thrombus. Recurrent HCC was treated with monthly transcatheter arterial infusion chemotherapy (TAI) and conformal radiotherapy (RT) of 40 Gy. After TAI and RT procedures, the disseminated tumor and IVCTT completely disappeared. Four years after TAI and RT procedures, the tumors were well controlled with no local recurrence. About 6-7 years after spontaneous ruptured HCC, lung metastasis and spleen metastasis were detected and resected, respectively. The patient is still alive and doing well over 7 years after spontaneous ruptured HCC.
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan. sanefuji@surg2.med.kyushu-u.ac.jp.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Sanefuji
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Fukuzawa
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kai
authors.affiliation: Department of Radiology, Red Cross Hospital, Oita, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Takaki
authors.affiliation: Department of Pathology, Red Cross Hospital, Oita, Japan.
authors.forename: Yonemasu
authors.initials: Y
authors.lastname: Hirotoshi
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Motohiro
authors.affiliation: Department of Surgery, Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Wakasugi
keywords: HCC; IVCTT; RT; TACE; TAI