Aboona Majd B, Zhou Wendi, Wijarnpreecha Karn
Internal Medicine, Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Department of Pathology, Banner University Medical Center - Phoenix, Phoenix, USA.
Cureus. 2023 May 28;15(5):e39611. doi: 10.7759/cureus.39611. eCollection 2023 May.
Hepatocellular carcinoma (HCC) is a complication of end stage liver disease. Even rarer is right atrial tumor thrombus burden due to HCC. Common metastatic sites of HCC in descending order are lung, peritoneum, and bone. We present a patient with liver cirrhosis due to nonalcoholic fatty liver disease (NAFLD) admitted due to incidental finding of right atrial thrombus on echocardiography after missing HCC surveillance for four years. Patient received a computed tomography (CT) scan that showed an inconclusive liver lesion despite two liver biopsies, and patient was incidentally found to have clear cell HCC diagnosed after right hepatectomy. Right atrial thrombus was treated with surgical thrombectomy and pathology showed necrotic HCC thrombi in right atrium with bile pigment. Due to the possibility of tumor growth with extrahepatic manifestations, screening in compensated cirrhosis is essential.
肝细胞癌（HCC）是终末期肝病的一种并发症。因HCC导致右心房肿瘤血栓负荷的情况更为罕见。HCC常见的转移部位依次为肺、腹膜和骨。我们报告一例因非酒精性脂肪性肝病（NAFLD）导致肝硬化的患者，该患者在漏查HCC四年后，因超声心动图偶然发现右心房血栓而入院。患者接受了计算机断层扫描（CT），尽管进行了两次肝脏活检，但肝脏病变仍不明确，患者在右肝切除术后偶然被诊断为透明细胞HCC。右心房血栓通过手术取栓治疗，病理显示右心房有坏死的HCC血栓伴胆色素。由于肿瘤有肝外表现生长的可能性，对代偿期肝硬化患者进行筛查至关重要。
