Clinical Gastroenterology and Hepatology
Volume 6, Issue 10 , Pages e39-e40, October 2008

Hepatocellular Carcinoma With Invasion Into Right Atrium

  • Jai–Jen Tsai

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Chien–Wei Su

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    • Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Han–Chieh Lin

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan

Article Outline

 

An 88-year-old male patient with a history of hypertensive cardiovascular disease, diabetes mellitus, and hyperlipidemia was admitted to the hospital because of chest pain, poor appetite, and body weight loss of 3 kg for 2 months. After admission, physical examinations disclosed 1 palpable mass over epigastric area. The electrocardiogram showed sinus tachycardia without ST change. The laboratory data of cardiac enzyme were within the normal range. Blood serologic tests revealed positive hepatitis B virus surface antigen, but antibody against hepatitis C virus was negative. In addition, elevated alpha-fetoprotein (715 ng/mL; normal, <20 ng/mL) was also found. The abdominal sonography disclosed 1 huge hepatic tumor over lateral segment of left lobe with small amount of ascites. Computed tomography scan showed 1 huge tumor that measured 11 × 6.5 cm in size located at lateral segment of liver (Figure A). In addition, right atrium was filled with soft tissue mass, with tumor thrombus in hepatic vein and inferior vena cava (B, C). Hence, the diagnosis of hepatocellular carcinoma (HCC) with invasion to inferior vena cava and right atrium was established. Because of old age and poor general condition, the patient received supportive care.

HCC is one of the leading causes of cancer mortality in the world. The common organs of metastasis from HCC are lung, bone, brain, and adrenal glands.1 For vascular system, it was reported that up to 60%–90% of patients with HCC greater than 5 cm in size had microscopic vascular invasion at diagnosis.2 Nevertheless, the incidence of HCC with direct invasion to heart was only around 1%–4%.3 The clinical manifestations are diverse, ranging from asymptomatic status, chest pain, dyspnea, and syncope to right-side heart failure. The prognosis of HCC with atrium invasion is very dismal. Surgical resection, liver transplantation, transarterial chemoembolization, as well as systemic chemotherapy have been reported as the therapeutic modalities for this disease.4 But the median survival was around 2–20 months in spite of therapy.3, 4 For patients who are among the high-risk groups of HCC with cardiac symptoms, physicians should keep a high index of suspicion to this rare but reported diagnosis.

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References 

  1. Sasaki A, Kai S, Endo Y, et al. Hepatitis B virus infection predicts extrahepatic metastasis after hepatic resection in patients with large hepatocellular carcinoma. Ann Surg Oncol. 2007;14:3181–3187
  2. Llovet JM, Bruix J. Novel advancement in the management of hepatocellular carcinoma. J Hepatol. 2008;48:S20–S37
  3. Kumar B, Jha S. Hepatocellular carcinoma with extension into the right atrium. Am J Med. 2005;118:1436–1440
  4. Mansour Z, Gerelli S, Kindo MJ. Right atrial metastasis from hepatocellular carcinoma. J Cardiac Surg. 2007;22:224–239

PII: S1542-3565(08)00732-5

doi:10.1016/j.cgh.2008.07.011

Clinical Gastroenterology and Hepatology
Volume 6, Issue 10 , Pages e39-e40, October 2008