Esposito Phillip, Matteo Mika, Concepcion Carissa, Montanarella Matthew, Matteo Jerry
Radiology, University of Florida College of Medicine, Jacksonville, USA.
Cureus. 2021 Jan 21;13(1):e12845. doi: 10.7759/cureus.12845.
Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and a leading cause of cancer mortality worldwide. HCC commonly results from longstanding liver cirrhosis, which presents a host of complications and a severely diminished quality of life. Despite advancements in diagnosis, molecular pathogenesis, and management of the complications associated with irreversible liver diseases, HCC remains an aggressive malignancy with high mortality. HCC is often invasive to adjacent vasculature, including the inferior vena cava (IVC) and portal veins, which present with rapid morbidity and patient decline. This article describes a patient with cirrhosis and HCC previously treated with cryoablation now presenting with multiple new foci and invasion of the left medial portal vein. These lesions were synchronously cryoablated. Cryoablation is typically reserved for solid tumor masses within the soft tissue or specific organs. This report illustrates a technique of directly cryoablating tumors within vessels. We achieved adequate cryoablation of the intravascular HCC portal vein tumor thrombus in the left medial portal vein. A one-month follow-up CT scan demonstrated significant portal vein macrovascular invasion (MVI) regression from 22.8 mm to 7.7 mm. Portal vein invasion by HCC presents unique challenges and traditionally precludes percutaneous or surgical therapy. Our technique shows successful cryoablation of MVI as a viable adjunct to treatment in select patients.
肝细胞癌（HCC）是最常见的肝脏恶性肿瘤，也是全球癌症死亡的主要原因。HCC通常由长期肝硬化引起，肝硬化会带来一系列并发症，并严重降低生活质量。尽管在诊断、分子发病机制以及与不可逆肝脏疾病相关的并发症管理方面取得了进展，但HCC仍然是一种侵袭性很强、死亡率很高的恶性肿瘤。HCC常侵犯邻近血管，包括下腔静脉（IVC）和门静脉，导致病情迅速恶化，患者身体状况下降。本文描述了一名曾接受过冷冻消融治疗的肝硬化合并HCC患者，目前出现多个新病灶并侵犯左内侧门静脉。对这些病灶同步进行了冷冻消融。冷冻消融通常适用于软组织或特定器官内的实体肿瘤块。本报告阐述了一种直接对血管内肿瘤进行冷冻消融的技术。我们成功地对左内侧门静脉内的血管内HCC门静脉肿瘤血栓进行了充分的冷冻消融。术后1个月的CT扫描显示门静脉大血管侵犯（MVI）明显消退，从22.8毫米降至7.7毫米。HCC侵犯门静脉带来了独特的挑战，传统上排除了经皮或手术治疗。我们的技术表明，在特定患者中，成功对MVI进行冷冻消融是一种可行的辅助治疗方法。
