This is the case of 60 year-old male patient, with a large
hepatocellular carcinoma on alcoholic chronic hepatitis.
He was completely asymptomatic. Hepatic ultrasound, occasionally
performed, showed a large hyperecogen nodule in the right
hemiliver. Abdominal CT scan confirmed a 12 cm tumor involving
the right hemiliver, and a second nodule of 9 cm in the segment
4 (fig. 1 and 2). |
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| Fig 1 and 2 . Abdominal CT scan showing the large tumour
of the right hemiliver of 12 cm and the other nodule of 9 cm
in the segment 4. |
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Biopsy of the tumor made the
diagnosis of well differentiated hepatocellular carcinoma.
Before referral to our Unit, a trans-arterial chemoemolization
was attempted. Angiography, in the diagnostic phase, showed a
complete occlusion of the right hepatic artery with evident
collateral circles; therefore chemoembolization was not
performed (fig. 3 and 4). |
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Fig 3 and 4. Angiography
showing complete occlusion of the right hepatic artery with
collateral circles. |
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After referall to Our Unit a right
hepatectomy extended to segment 4 was planned. The patient was
classified as Class A accrding to Child-Pugh classification. Serum
alphafetoprotein levels, AST and ALT leves were normal; there were
not esophageal varices.After bilateral
subcostal laparotomy, hypertrophy of left lobe was confirmed.The patient underwent
right hepatectomy extended to segment 4 and to part of the
segment 2 and 3 (Fig. 5). |
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| Fig 5: the remnant liver is hypertrophic; left hepatic vein
is encircled with a white loop. Cut surface with absorbable
clips is visible. A transcystic biliary drainage was left
in place |
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Resection was performed with intermittent
pedicle clamping of 38 min. On the surgical specimen the
right hemiliver is completely substituted by a large capsulated
tumour (fig 6) and the second nodule involves segment 4 and
part of segment 2 and 3 (fig 7). There was no intra and postoperative
blood transfusions, postoperative outcome was uneventfull;
pathology confirmed the diagnosis of hepatocellular carcinoma
on chronic hepatitis.
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| Fig 6: surgical specimen: the right hemiliver
is completely substituted by the neoplastic lesion |
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| Fig 7: the second nodule has a capsula; the
necrosis of he central part of lesion is evident. |
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