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MULTIPLE HEPATOCELLULAR CARCINOMA: LIVER RESECTION ASSOCIATED TO RF ABLATION
dr. M. Giordano
Hepato-biliary
and Digestive Surgery Unit
68 year-old male patient with HCC on HCV-related hepatitis. The patient was asymptomatic. During the usual follow-up for hepatitis, liver US showed a hyperecogen nodule in the segment 2 and 4. Abdominal CT-scan confirmed a 7 cm tumor in the left hemiliver closely related to the junction of the left and middle hepatic veins to the vena cava, with a complete peritumoral capsula (arrows), and another nodule of 2 cm in the segment 5 (arrows). (Fig 1 and 2) |
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Fig.1 |
Fig.2 |
The patient was classified as Child Pugh Class A, without portal hypertension. Serum alphafetoprotein levels were 220 ng/ml. The ICG 15’ retention test was 13%.
He underwent to resection of the main nodule, with preservation of segment 2 and 3, and to radiofrequency ablation of the nodule in the segment 5 (Fig. 3 and 4). Resection was performed with intermittent clamping of hepatic pedicle and of common venous trunk (45 min). There was no intra and postoperative blood transfusion, postoperative outcome was uneventfull. |
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Fig.3 |
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Fig.4 |
The tumor was a 8 cm plurinodular capsulated hepatocellular carcinoma with focal necrosis on cirrhosis. (Fig 5 and 6) |
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Fig.5 |
Fig.6 |
Thirty days after resection, abdominal CT-scan showed no vital tissue in the ablated nodule in the segment 5. (Fig 7 and 8). |
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Fig.7 |
Fig.8 |
Ninety days after the procedure, neoadjuvant Trans-Arterial Chemoinfusion with Carboplatinum (450 mg) was performed: diagnostic angiography did not showed any hypervascularized nodule in the segment 5. (Fig 9, 10 and 11). |
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Fig.9 |
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Fig.11 |
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