Advertisement

CardioVascular and Interventional Radiology

, Volume 38, Issue 4, pp 1031–1035 | Cite as

Percutaneous Irreversible Electroporation of a Large Centrally Located Hepatocellular Adenoma in a Woman with a Pregnancy Wish

  • Hester J. Scheffer
  • Marleen C. A. M. Melenhorst
  • Aukje A. J. M. van Tilborg
  • Karin Nielsen
  • Karin M. van Nieuwkerk
  • Richard A. de Vries
  • Petrousjka (M.P.) van den Tol
  • Martijn R. Meijerink
Case Report

Abstract

Irreversible electroporation (IRE) is a novel image-guided ablation technique that is rapidly gaining popularity in the treatment of malignant liver tumors located near large vessels or bile ducts. We describe a 28-year-old female patient with a 5 cm large, centrally located hepatocellular adenoma who wished to get pregnant. Regarding the risk of growth and rupture of the adenoma caused by hormonal changes during pregnancy, treatment of the tumor was advised prior to pregnancy. However, due to its central location, the tumor was considered unsuitable for resection and thermal ablation. Percutaneous CT-guided IRE was performed without complications and led to rapid and impressive tumor shrinkage. Subsequent pregnancy and delivery went uncomplicated. This case report suggests that the indication for IRE may extend to the treatment of benign liver tumors that cannot be treated safely otherwise.

Keywords

Irreversible electroporation (IRE) Electroporation/methods Hepatocellular adenoma/HCA Pregnancy Tumor ablation/percutaneous Ablation techniques/adverse effects 

Notes

Conflict of interest

Hester J Scheffer, Marleen CAM Melenhorst, Aukje AJM van Tilborg, Karin Nielsen, Karin M van Nieuwkerk, Richard A de Vries, Petrousjka (MP) van den Tol and Martijn R Meijerink have no conflicts of interest to declare.

Informed Consent

Informed consent was provided by the patient.

References

  1. 1.
    Terkivatan T, de Wilt JHW, de Man RA, Ijzermans JNM (2000) Management of hepatocellular adenoma during pregnancy. Liver 20:186–187PubMedCrossRefGoogle Scholar
  2. 2.
    Agrawal S, Agarwal S, Arnason T et al (2014) Management of hepatocellular adenoma: recent Advances. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2014.05.023 PubMedGoogle Scholar
  3. 3.
    Almashhrawi AA, Ahmed KT, Rahman RN et al (2013) Liver diseases in pregnancy: diseases not unique to pregnancy. World J Gastroenterol 19:7630–7638PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Bröker MEE, Ijzermans JNM, van Aalten SM et al (2012) The management of pregnancy in women with hepatocellular adenoma: a plea for an individualized approach. Int J Hepatol 2012:725735PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Lee EW, Thai S, Kee ST (2010) Irreversible electroporation: a novel image-guided cancer therapy. Gut Liver 4(Suppl 1):S99–S104PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Van Tilborg AAJM, Scheffer HJ, Nielsen K et al (2014) Transcatheter CT arterial portography and CT hepatic arteriography for liver tumor visualization during percutaneous ablation. J Vasc Interv Radiol. 25:1–15. doi: 10.1016/j.jvir.2014.02.008 CrossRefGoogle Scholar
  7. 7.
    Ball C, Thomson KR, Kavnoudias H (2010) Irreversible electroporation: a new challenge in “out of operating theater” anesthesia. Anesth Analg 110:1305–1309PubMedCrossRefGoogle Scholar
  8. 8.
    Cobey FC, Salem RR (2004) A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management. Am J Surg 187:181–191PubMedCrossRefGoogle Scholar
  9. 9.
    Van der Sluis FJ, Bosch JL, Terkivatan T et al (2009) Hepatocellular adenoma: cost-effectiveness of different treatment strategies. Radiology 252:737–746PubMedCrossRefGoogle Scholar
  10. 10.
    Noels JE, van Aalten SM, van der Windt DJ et al (2011) Management of hepatocellular adenoma during pregnancy. J Hepatol 54:553–558PubMedCrossRefGoogle Scholar
  11. 11.
    Atwell TD, Brandhagen DJ, Charboneau JW et al (2005) Successful treatment of hepatocellular adenoma with percutaneous radiofrequency ablation. AJR Am J Roentgenol 184:828–831PubMedCrossRefGoogle Scholar
  12. 12.
    Karkar AM, Tang LH, Kashikar ND et al (2013) Management of hepatocellular adenoma: comparison of resection, embolization and observation. HPB (Oxford) 15:235–243CrossRefGoogle Scholar
  13. 13.
    Davalos RV, Mir LM, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33:223–231PubMedCrossRefGoogle Scholar
  14. 14.
    Cannon R, Ellis S, Hayes D et al (2012) Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 107:544–549PubMedCrossRefGoogle Scholar
  15. 15.
    Kingham TP, Karkar AM, D’Angelica MI et al (2012) Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg 215:379–387PubMedCrossRefGoogle Scholar
  16. 16.
    Scheffer HJ, Nielsen K, van Tilborg AA, Vieveen JM et al (2014) Ablation of colorectal liver metastases by irreversible electroporation: results of the COLDFIRE-I ablate-and-resect study. Eur Radiol 24:2467–2475PubMedCrossRefGoogle Scholar
  17. 17.
    Scheffer HJ, Nielsen K, de Jong MC et al (2014) Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. J Vasc Interv Radiol 25:997–1011PubMedCrossRefGoogle Scholar
  18. 18.
    Lee YJ, Lu DSK, Osuagwu F, Lassman C (2013) Irreversible electroporation in porcine liver: acute computed tomography appearance of ablation zone with histopathologic correlation. J Comput Assist Tomogr 37:154–158PubMedCrossRefGoogle Scholar
  19. 19.
    Ben-David E, Ahmed M, Faroja M et al (2013) Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties. Radiology 269:738–747PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Corovic S, Lackovic I, Sustaric P et al (2013) Modeling of electric field distribution in tissues during electroporation. Biomed Eng Online 12:1–27CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Hester J. Scheffer
    • 1
  • Marleen C. A. M. Melenhorst
    • 1
  • Aukje A. J. M. van Tilborg
    • 1
  • Karin Nielsen
    • 2
  • Karin M. van Nieuwkerk
    • 3
  • Richard A. de Vries
    • 3
  • Petrousjka (M.P.) van den Tol
    • 2
  • Martijn R. Meijerink
    • 1
  1. 1.Department of Radiology and Nuclear MedicineVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of SurgeryAmsterdamThe Netherlands
  3. 3.Department of Gastroenterology and HepatologyVU University Medical CenterAmsterdamThe Netherlands

Personalised recommendations