Cover Image

Intra-atrial Thrombosis Complicating Hepatocellular Carcinoma with Positive Clinical Response to Sorafenib: A Case Report and Review of Literature

Maxime Delvincourt

Abstract


Introduction: Tumoral thrombus extension to inferior vena cava (IVC) and right atrium is an infrequent complication of hepatocellular carcinoma (HCC), with dismal prognosis and poorly codified treatment.

Presentation of case: We report the case of a 58-year-old man diagnosed with stage IV HCC in the right lobe of the liver, with intracavitary cardiac involvement. Under Sorafenib, the patient showed quick favourable clinical response, with decrease of the dyspnea and edema, but severe adverse effects led to early treatment discontinuation. We review the different therapeutic approaches to advanced HCC with cardiac extension.

Conclusion: Patients with intra-atrial thrombosis complicating hepatocellular carcinoma, when not eligible for surgery, might benefit from Sorafenib, to alleviate symptoms and prevent short-term cardio-vascular complications.


Keywords


Hepatobiliary cancer; chemotherapy

Full Text:

PDF

References


Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005, 55:74-108

Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012, 379:1245-1255

Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Horana AA. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res. 2008, 122:299-306

Llovet J, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J; SHARP Investigators Study Group. Sorafenib in Advanced Hepatocellular Carcinoma. N Engl J Med. 2008, 359:378-390

Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, Xu J, Sun Y, Liang H, Liu J, Wang J, Tak WY, Pan H, Burock K, Zou J, Voliotis D, Guan Z, Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009, 10:25-34

Pawarode A, Voravud N, Sriuranpong V, Kullavanijaya P, Patt YZ. Natural history of untreated primary hepatocellular carcinoma: a retrospective study of 157 patients. Am J Clin Oncol. 1998, 21:386-391

Kojiro M, Nakahara H, Sugihara S, Murakami T, Nakashima T, Kawasaki H. Hepatocellular carcinoma with intra-atrial tumor growth. A clinicopathologic study of 18 autopsy cases. Arch Pathol Lab Med. 1984, 108:989-992

Tse HF, Lau CP, Lau YK, Lai CL.Transoesophageal echocardiography in the detection of inferior vena cava and cardiac metastasis in hepatocellular carcinoma. Clin Cardiol. 1996, 19:211-213

Kim SU, Kim YR, Kim do Y, Kim JK, Lee HW, Kim BK, Han KH, Chon CY, Moon YM, Ahn SH. Clinical features and treatment outcome of advanced hepatocellular carcinoma with inferior vena cava invasion or atrial tumor thrombus. Korean J Hepatol. 2007, 13:387-395

Diaz Castro O, Bueno H, Nebreda LA. Acute myocardial infarctioncaused by paradoxical tumorous embolism as a manifestation ofhepatocarcinoma. Heart. 2004, 90:e29

Murakawa T, Takamoto S, Ezure M, Ono M, Kawauchi M, Tanaka O. Metastatic hepatocellular carcinoma obstructing the right ventricular outflow tract. Jpn J Thorac Cardiovasc Surg. 2000, 48:516-519

Wilson K, Guardino J, Shapira O. Pulmonary tumor embolism as a presenting feature of cavoatrial hepatocellular carcinoma. Chest. 2001, 119:657-658

DeVita VT, Trujillo NP, Blackman AH, Ticktin HE. Pulmonary manifestations of primary hepatic carcinoma. Am J Med Sci. 1965, 250:428-364

Wang Y, Yuan L, Ge RL, Sun Y, Wei G. Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol. 2013, 20:914-922

Shudo Y, Matsumiya G, Sakaguchi T, Fujita T, Yamauchi T, Sawa Y. Resection of Advanced Stage Malignant Retroperitoneal Neoplasms with Tumor Thrombus Extending into the Right Atrium: Report of Four Cases. Surg Today. 2011, 41:262-265

Kashima Y, Miyazaki M, Ito H, Kaiho T, Nakagawa K, Ambiru S, Shimizu H, Furuya S, Nakajima N. Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein. J Gastroenterol Hepatol. 1999, 14:922-927

Sun JH, Zhang YL, Nie CH, Chen LM, He JD, Wang WL, Zheng SS. Long-term survival after chemoembolization of metastatic right atrial tumor thrombus as a presenting feature of hepatocellular carcinoma: A case study. Oncol Lett. 2012, 3:975-977

Yau T, Chan P, Ng KK, Chok SH, Cheung TT, Fan ST, Poon RT. Phase 2 open-label study of single-agent sorafenib in treating advanced hepatocellular carcinoma in a hepatitis B-endemic Asian population: presence of lung metastasis predicts poor response. Cancer. 2009, 115:428-436

Irtan S, Chopin-Laly X, Ronot M, Faivre S, Paradis V, Belghiti J. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection; Liver Int. 2011, 31:740-743

Kim MS, Jin YJ, Lee JW, Lee JI, Kim YS, Lee SY, Chae MH. Complete remission of advanced hepatocellular carcinoma by sorafenib: A case report. World J Gastrointest Oncol. 2013, 5:38-42

Vallakati A, Chandra PA, Frankel R, Shani J. Intra-atrial tumor thrombi secondary to hepatocellular carcinoma responding to chemotherapy. North Am J Med Sci. 2011, 3:435-437


Refbacks

  • There are currently no refbacks.


AJCC-REP (ISSN 2572-5742)Copyright © 2012-2020. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States