Hepatology International

, Volume 3, Issue 3, pp 509–515

Diffuse intrahepatic recurrence after percutaneous radiofrequency ablation for solitary and small hepatocellular carcinoma

Authors

  • Yoshiyuki Mori
    • Second Department of Internal MedicineWakayama Medical University
    • Second Department of Internal MedicineWakayama Medical University
  • Naoki Shingaki
    • Second Department of Internal MedicineWakayama Medical University
  • Kosaku Moribata
    • Second Department of Internal MedicineWakayama Medical University
  • Tatsuya Shiraki
    • Second Department of Internal MedicineWakayama Medical University
  • Hisanobu Deguchi
    • Second Department of Internal MedicineWakayama Medical University
  • Kazuki Ueda
    • Second Department of Internal MedicineWakayama Medical University
  • Shotaro Enomoto
    • Second Department of Internal MedicineWakayama Medical University
  • Hiroto Magari
    • Second Department of Internal MedicineWakayama Medical University
  • Izumi Inoue
    • Second Department of Internal MedicineWakayama Medical University
  • Takao Maekita
    • Second Department of Internal MedicineWakayama Medical University
  • Mikitaka Iguchi
    • Second Department of Internal MedicineWakayama Medical University
  • Kimihiko Yanaoka
    • Second Department of Internal MedicineWakayama Medical University
  • Masashi Oka
    • Second Department of Internal MedicineWakayama Medical University
  • Masao Ichinose
    • Second Department of Internal MedicineWakayama Medical University
Case Report

DOI: 10.1007/s12072-009-9131-4

Cite this article as:
Mori, Y., Tamai, H., Shingaki, N. et al. Hepatol Int (2009) 3: 509. doi:10.1007/s12072-009-9131-4

Abstract

Two patients developed segmental, diffuse intrahepatic recurrence after percutaneous radiofrequency ablation (RFA) to treat a primary, solitary, and small (2.5 cm) hepatocellular carcinoma (HCC). Despite the size of the HCC, levels of the tumor markers (α-fetoprotein, α-fetoprotein-L3%, and des-γ-carboxyprothrombin) were all elevated before RFA, and tumors in both patients were contiguous with a major branch of the portal vein. Tumor biopsies of both patients revealed moderately differentiated HCC but diagnostic imaging showed an area of reduced tumor blood flow, suggesting a poorly differentiated component. Since early detection of post-RFA malignancies by standard ultrasonography and contrast-enhanced computed tomography was difficult, the most sensitive indicator of recurrence in these two patients was the elevated tumor markers. The diffuse intrahepatic recurrence was thought to be caused by increased intratumoral pressure during RFA, resulting in the dissemination of cancer cells through the contiguous portal vein. The clinical course of these tumors indicate that the choice of RFA should be carefully considered when treating specific subtype of HCC that is adjacent to main portal vein branch and involves a possible poorly differentiated component and that surgical resection or combinations of RFA with other treatment modalities such as transcatheter arterial chemoembolization should be considered as alternative treatment strategies.

Keywords

Hepatocellular carcinomaRadiofrequency ablationDisseminationDiffuse recurrence

Copyright information

© Asian Pacific Association for the Study of the Liver 2009