The patient was 66 years old, with a history of hepatitis B. The patient was found to have right hepatic occupancy and portal vein cancer thrombus on ultrasound during physical examination, and the MRI and whole body PET-CT examination suggested right hepatic cancer and portal vein cancer thrombus.
CT arterial stage lesion was not obviously enhanced, and portal stage lesion was hypointense with unclear boundary.
The portal phase lesion was hypointense.
The portal lesion was hypointense.
The portal lesion is hypointense.
The portal lesion is hypodense.
Portal carcinoma thrombus is hypointense.
Portal carcinoma thrombus
TACE was performed after pathological examination, and hepatic artery portal vein shunt was seen (not except related to biopsy injury). The tumor artery blood supply is not abundant. Pathology was seen to be anisocytic and resent for examination if necessary.
The lesion was slightly reduced after TACE and scattered iodine oil deposits were seen.
Ar-He knife cryoablation treatment was performed on July 22, 2015, with multiple Ar-He knife cryoablation needles to puncture the right hepatic tumor and the right branch of portal vein cancer thrombus with ablation, and hypodense changes were seen in the tumor and its periphery after two rounds.
The cryo-ice ball basically covered the tumor.
The cryo-ice ball basically covered the tumor.
The frozen ice ball basically covered the tumor.
The frozen ice ball basically covered the tumor.
Cryotherapy of right hepatocellular carcinoma and right branch portal vein cancer thrombus.
Postoperative treatment such as liver protection, anti-inflammation and hemostasis to improve immunity and stomach protection, etc. Three days after surgery, the patient experienced chest tightness and shortness of breath, fatigue, poor nausea, dizziness and other discomfort, and petechiae appeared on the skin.
On July 25, 2015, an emergency blood test was performed with HB 102G/L,PLT 5*10^9/L.
Platelet transfusion and symptomatic treatment were given.
Two days later the patient’s symptoms worsened and a chest radiograph suggested a large right pleural effusion and a puncture tube was placed for drainage. A large amount of bloody pleural fluid was induced.
HB 65G/L and PLT 39*10^9/L were retested.
Blood transfusion was given and supportive treatment was continued.
On July 29, HB 90G/L PLT 60G/L.
The patient was discharged after gradual improvement.
On review on October 12, 2015, the patient’s tumor was significantly reduced and non-enhancing with normal AFP.
No enhancement was seen in the original tumor area.
No enhancement was seen in the original tumor area.
The original portal vein cancer thrombus was shrunken than before and no significant enhancement was seen.
The portal vein cancer thrombus was shrunken and no enhancement was seen.
December 2015 No enhancement was seen in the original tumor area, but a new subfoci in the right liver.
The original right liver tumor area was not seen to strengthen and was significantly smaller.
No enhancement was seen in the original right liver tumor.
The original portal vein cancer thrombus area was further reduced.
Radiofrequency ablation was performed for the new subfoci.
AFP 2.8ng/ml was rechecked after treatment.
Point of view.
The patient had a chance of surgical treatment for right hepatocellular carcinoma with portal vein right branch thrombus, but the patient decided to give up surgery and requested ablation treatment after consulting several tertiary hospitals for hepatobiliary surgery.
The patient’s biopsy pathology was anisocytic, but the diagnosis of hepatocellular carcinoma could be established with the clinical data.
The tumor arterial blood supply was not rich, and the iodine oil deposition after interventional embolization was only average. The tumor was large, the boundary was unclear, and there seemed to be a small subfoci around it and there was a right branch of portal vein cancer thrombus. The patient did not have cirrhosis, and the preoperative platelets were 199*10^9/L. It was estimated that the patient could tolerate argon helium knife ablation treatment, so argon helium knife cryotherapy was adopted.
In order to achieve radical ablation, the scope of ablation was larger, and the portal vein cancer embolus was also directly punctured and frozen.
However, two days after the operation, the patient showed fatigue, chest tightness, dizziness, skin petechiae and other discomforts.
The patient developed a large amount of blood in the right side of the chest cavity after surgery, which gradually improved after placement of a tube for drainage. Generally, pleural effusion after thermal ablation of hepatocellular carcinoma can be easily restored to normal after drainage, but pleural effusion after cryoablation with argon helium knife needs a longer time to stabilize, which may be related to abnormal coagulation function and bleeding cannot really stop.
The patient recovered well after red suspension platelet transfusion and hemostatic treatment, and several times of re-examination showed that the original tumor was basically ablated and the portal vein cancer thrombus was gradually reduced.
Six months later, a small subfoci appeared in the right liver of the patient, and radiofrequency ablation was performed. Minimally invasive and repeatable is one of the advantages of ablation therapy.