This is a case of 39 years-old
man, who had undergone left inferior pulmonary lobectomy for bronchial
carcinoid 8 years before our observation. An abdominal US performed
for occasional abdominal pain showed a very large lesion of the
liver. Abdominal CT scan (>Fig. 1) and MRI documented a huge lesion
involving the whole right liver, the segment IV (left paramedian
segment) and the caudate lobe. The hepatic pedicle and the retrohepatic
vena cava were considerably compressed. Fine needle biopsy documented
a metastasis of carcinoid tumor. Urinary levels of 5-HIAA was 39
mg/24h (n.v. < 10 mg/24h). |
The patient was referred to
our Unit after a treatment with arterial chemoembolization with
an emulsion of cysplatin and lipiodol, without any change of the
tumor and of the urinary levels of 5-HIAA. The tumor was technically
resectable, but the left lobe, that is segments 2 and 3 (left lateral
segment), accounted for less than 25% of the whole liver, as resulted
with the spiral-CT volumetric assessment, and the risk of postoperative
liver failure was very high. A preoperative right portal embolization (Fig.3) was performed to obtain a hypertrophy of the left
lobe. In this case titanium coils were used to embolize the right
portal branch. |
