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A case of hepatocellular carcinoma with pseudoaneurysm formation upon lenvatinib administration

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Abstract

A 79-year-old man received treatment for multiple intrahepatic hepatocellular carcinoma with atezolizumab + bevacizumab. However, he developed lower back pain attributed to spinal metastases upon tumor enlargement; thus, he was admitted to our hospital for a change from atezolizumab + bevacizumab to lenvatinib and radiation therapy for the spinal metastases. On the 11th day after starting lenvatinib treatment, a pulsatile aneurysm appeared in the tumor, detected using abdominal ultrasonography Micro B-flow imaging, which visualized blood flow at a high frame rate; this was diagnosed as a pseudoaneurysm. The patient refused treatment for the pseudoaneurysm; therefore, he was carefully followed up. Fortunately, the pseudoaneurysm disappeared on the 17th day. One month later, the tumor had become completely necrotic. Lenvatinib demonstrated effectiveness in inhibiting angiogenesis in the tumor, as evidenced by a decrease in tumor blood flow. This case report suggests that pseudoaneurysm formation within the tumor occurs early after the administration of lenvatinib; thus, clinicians must be aware of the potential risk of pseudoaneurysm rupture.

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References

  1. Tanaka S, Kitamura T, Fujita M, et al. Color Doppler flow imaging of liver tumors. AJR Am J Roentgenol. 1990;154:509–14.

    Article  CAS  PubMed  Google Scholar 

  2. Adachi Y, Matsuki M, Watanabe H, et al. Antitumor and antiangiogenic activities of lenvatinib in mouse xenograft models of vascular endothelial growth factor-induced hypervascular human hepatocellular carcinoma. Cancer Invest. 2019;37:185–98.

    Article  CAS  PubMed  Google Scholar 

  3. Muraishi N, Kawamura Y, Akuta N, et al. The impact of lenvatinib on tumor blood vessel shrinkage of hepatocellular carcinoma during treatment: an imaging-based analysis. Oncology. 2023;101:134–44.

    Article  CAS  PubMed  Google Scholar 

  4. Tamai F, Furuse J, Maru Y, et al. Intrahepatic pseudoaneurysm: a complication following radio-frequency ablation therapy for hepatocellular carcinoma. Eur J Radiol. 2002;44:40–3.

    Article  PubMed  Google Scholar 

  5. Evangelos T, Vassiliki P, Dimitrios K, et al. Hepatic artery aneurysm complicating intra-arterial chemotherapy for hepatocellular carcinoma. Hepatogastroenterology. 2003;50:830–1.

    PubMed  Google Scholar 

  6. Yoshikawa S, Asano T, Watanabe M, et al. Rupture of hepatic pseudoaneurysm formed nine years after carbon ion radiotherapy for hepatocellular carcinoma. Intern Med. 2019;58:2639–43.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kuorda H, Abe T, Fujiwara Y, et al. Change in arterial tumor perfusion is an early biomarker of lenvatinib efficacy in patients with unresectable hepatocellular carcinoma. World J Gastroenterol. 2019;25:2365–72.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sugimoto K, Moriyasu F, Saito K, et al. Hepatocellular carcinoma treated with sorafenib: early detection of treatment response and major adverse events by contrast-enhanced US. Liver Int. 2013;33:605–15.

    Article  CAS  PubMed  Google Scholar 

  9. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  PubMed  Google Scholar 

  10. Enomoto H, Ueno Y, Hiasa Y, et al. The transition in the etiologies of hepatocellular carcinoma-complicated liver cirrhosis in a nationwide survey of Japan. J Gastroenterol. 2021;56:158–67.

    Article  CAS  PubMed  Google Scholar 

  11. Katyal S, Oliver JH 3rd, Peterson MS, et al. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703.

    Article  CAS  PubMed  Google Scholar 

  12. Leowattana W, Leowattana T, Leowattana P. Systemic treatment for unresectable hepatocellular carcinoma. World J Gastroenterol. 2023;29:1551–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lu Y, Hu JG, Lin XJ, et al. Bone metastases from hepatocellular carcinoma: clinical features and prognostic factors. Hepatobiliary Pancreat Dis Int. 2017;16:499–505.

    Article  CAS  PubMed  Google Scholar 

  14. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681–93.

    Article  PubMed  Google Scholar 

  15. Yamamoto Y, Matsui J, Matsushima T, et al. Lenvatinib, an angiogenesis inhibitor targeting VEGFR/FGFR, shows broad antitumor activity in human tumor xenograft models associated with microvessel density and pericyte coverage. Vasc Cell. 2014;6:18.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yang ZF, Poon RT. Vascular changes in hepatocellular carcinoma. Anat Rec (Hoboken). 2008;291:721–34.

    Article  CAS  PubMed  Google Scholar 

  17. Haider Z, Idris M, Sajjad Z, et al. Intratumoral pseudoaneurysms in hepatocellular carcinoma: do they occur de novo without any prior intervention? A tertiary care center experience of 6 years. Acta Radiol. 2015;56:1027–33.

    Article  PubMed  Google Scholar 

  18. Ch’ng LS, Tazuddin EEM, Young B, et al. Spontaneous resolution of asymptomatic hepatic pseudoaneurysm post radiofrequency ablation. BJR Case Rep. 2016;2:20150306.

    PubMed  PubMed Central  Google Scholar 

  19. O’Driscoll D, Olliff SP, Olliff JF. Hepatic artery aneurysm. Br J Radiol. 1999;72:1018–25.

    Article  CAS  PubMed  Google Scholar 

  20. Lu M, Weiss C, Fishman EK, et al. Review of visceral aneurysms and pseudoaneurysms. J Comput Assist Tomogr. 2015;39:1–6.

    Article  PubMed  Google Scholar 

  21. Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72:3S-39S.

    Article  PubMed  Google Scholar 

  22. Wu XY, Shi XL, Zhou JX, et al. Life-threatening hemorrhage after liver radiofrequency ablation successfully controlled by transarterial embolization. World J Hepatol. 2012;4:419–21.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Boyd-Tressler A, Follette C, Oechsel K, et al. Spontaneous rupture of nontraumatic hepatic artery pseudoaneurysm. J Surg Case Rep. 2023;2023:rjad201.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ohara H, Ishibashi Y, Yoshimura S, et al. Intratumoral pseudoaneurysm within a liver metastasis of gastric cancer: a case report. Surg Case Rep. 2020;6:39.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Guyon J, Gouverneur A, Maumus-Robert S, et al. Association between antiangiogenic drugs used for cancer treatment and artery dissections or aneurysms. JAMA Oncol. 2021;7:775–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mitsuyama Y, Kageyama K, Shinkawa H, et al. Atezolizumab plus bevacizumab-induced intratumoral hemorrhage in a patient with rib metastasis from unresectable hepatocellular carcinoma. Radiol Case Rep. 2023;18:3037–40.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sato A, Imai Y, Uchiya H, et al. Two cases of intraabdominal bleeding caused by hepatocellular carcinoma rupture soon after the initiation of chemotherapy with lenvatinib. Intern Med. 2022;61:2301–5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Uchida-Kobayashi S, Kageyama K, Yamamoto A, et al. Lenvatinib-induced tumor-related hemorrhages in patients with large hepatocellular carcinomas. Oncology. 2021;99:186–91.

    Article  CAS  PubMed  Google Scholar 

  29. Seki A, Hori S, Shimono C. Management of vascular lake phenomenon on angiography during chemoembolization with superabsorbent polymer microspheres. Jpn J Radiol. 2015;33:741–8.

    Article  CAS  PubMed  Google Scholar 

  30. Wang S, Chen M, Zhang X, et al. Aneurysm and artery dissection following the use of vascular endothelial growth factor inhibitor: a real-world analysis using a spontaneous reporting system. J Am Heart Assoc. 2021;10: e020844.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Weskott HP. B-flow–a new method for detecting blood flow. Ultraschall Med. 2000;21:59–65.

    CAS  PubMed  Google Scholar 

  32. Furuse J, Maru Y, Mera K, et al. Visualization of blood flow in hepatic vessels and hepatocellular carcinoma using B-flow sonography. J Clin Ultrasound. 2001;29:1–6.

    Article  CAS  PubMed  Google Scholar 

  33. Jung EM, Kubale R, Jungius KP, et al. Vascularization of liver tumors-preliminary results with Coded Harmonic Angio (CHA), phase inversion imaging, 3D power Doppler and contrast medium-enhanced B-flow with second generation contrast agent (Optison). Clin Hemorheol Microcirc. 2006;34:483–97.

    CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan

    Ryo Yano, Masashi Hirooka, Yoshiko Nakamura, Yusuke Imai, Yohei Koizumi, Takao Watanabe, Osamu Yoshida, Yoshio Tokumoto, Masanori Abe & Yoichi Hiasa

Authors
  1. Ryo Yano
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  2. Masashi Hirooka
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  3. Yoshiko Nakamura
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  4. Yusuke Imai
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  6. Takao Watanabe
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  7. Osamu Yoshida
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  8. Yoshio Tokumoto
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  9. Masanori Abe
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  10. Yoichi Hiasa
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by RY, YN, YI, and MH. The first draft of the manuscript was written by RY, and all authors commented on all versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: TW, YK, MH; Methodology: OY, YT, MA; Writing-original draft preparation: RY; Writing—review and editing: MH; Supervision: YH.

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Correspondence to Masashi Hirooka.

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Ethical approval was not required because this was a case report. All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the 1975 Declaration of Helsinki, as revised in 2008.

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Informed consent was obtained from the patient for the publication of this case report.

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Yano, R., Hirooka, M., Nakamura, Y. et al. A case of hepatocellular carcinoma with pseudoaneurysm formation upon lenvatinib administration. Clin J Gastroenterol 17, 319–326 (2024). https://doi.org/10.1007/s12328-023-01914-7

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  • DOI: https://doi.org/10.1007/s12328-023-01914-7

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