Well-differentiated hepatocellular carcinoma smaller than 15 mm in diameter totally eradicated with percutaneous ethanol injection instead of radiofrequency ablation
Tóm tắt
We describe three cases of well-differentiated hepatocellular carcinoma (HCC) smaller than 15 mm in diameter completely eradicated with percutaneous ethanol injection (PEI) instead of using radiofrequency ablation (RFA). Ultrasound (US) examination revealed one nodule each in segment 2 (hypoechoic, near bile ducts, 10 mm), in segment 5 (hyperechoic, near the gall bladder, 15 mm), and in segment 7 (hypoechoic, near the diaphragm, 15 mm). Although imaging studies revealed isovascular (case 1) and hypervascular (cases 2 and 3) nodules, histological analysis of US-guided biopsy tissue revealed well-differentiated HCC. In consideration of the location of the nodules, PEI, instead of RFA, was administered and the nodules were rendered necrotic. Although RFA is superior to PEI in the treatment of small HCCs from the viewpoint of treatment response and long survival, PEI is strongly recommended for HCCs located near bile ducts, the gall bladder, and the diaphragm, especially when the nodules are smaller than 15 mm in diameter.
Tài liệu tham khảo
Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954;7:462–503
Okuda K, Peteres RL, Simson IW. Gross anatomic features of hepatocellular carcinoma from three disparate geographic areas. Proposal of new classification. Cancer 1984;54:2165–2173
Trevisani F, Caraceni P, Bernardi M, D’Intino PE, Arienti V, Amorati P, et al. Gross pathologic types of hepatocellular carcinoma in Italian patients. Relationship with demographic, environmental, and clinical factors. Cancer 1993;72:1557–1563
Okuda K. Early recognition of hepatocellular carcinoma. Hepatology 1986;6:729–738
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210:655–661
Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005;129:122–130
Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or = 4 cm. Gastroenterology 2004;127:1714–1723
Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapy. Hepatology 2009;49:453–459
Kasugai H, Osaki Y, Oka H, Kudo M, Seki T, Osaka Liver Cancer Study Group. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3891 ablations in 2614 patients. Oncology 2007;72:S72–S75
Takeuchi H, Arata T, Takehara K, Shigeyasu K, Kanazawa T, Murata H, et al. A patient who developed diaphragmatic hernia one year after percutaneous radiofrequency ablation for hepatocellular carcinoma. Kanzo 2007;48:458–462
Tomonaga C, Kawano A, Taguchi Y, Matsunaga T, Maruyama T, Toyoshima S, et al. Two cases of diaphragmatic hernia following percutaneous radiofrequency ablation of hepatocellular carcinoma. Kanzo 2007;48:529–537
Kanai T, Hirohashi S, Upton MP, Noguchi M, Kishi K, Makuuchi M, et al. Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer 1987;60:810–819
Nakashima O, Sugihara S, Kage M, Kojiro M. Pathomorphologic characteristics of small hepatocellular carcinoma: a special reference to small hepatocellular carcinoma with indistinct margins. Hepatology 1995;22:101–105
Kojiro M, Nakashima O. Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis 1999;19:287–296
Kondo Y, Niwa Y, Akikusa B, Takazawa H, Okabayashi A. A histopathologic study of early hepatocellular carcinoma. Cancer 1983;52:687–692
Nakashima T, Kojiro M. Hepatocellular Carcinoma: An Atlas of its Pathology. Tokyo: Springer-Verlag; 1987
Vilana R, Bruix J, Bru C, Ayuso C, Sole M, Rodes J. Tumor size determines the efficacy of percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Hepatology 1992;16:353–357
Kojiro M. The evolution of pathologic features of hepatocellular carcinoma. In Tabor E, editor. Viruses and Liver Cancer. Amsterdam: Elsevier; 2002. 113–122
Kojiro M. Pathology of Hepatocellular Carcinoma. Oxford: Blackwell; 2006. 39–49
Taniguchi M, Kim SR, Imoto S, Ikawa H, Ando K, Mita K, et al. Long-term outcome of percutaneous ethanol injection therapy for minimum-sized hepatocellular carcinoma. World J Gastroenterol 2008;14:1997–2002