#Gastroenterology

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Interventional Diagnosis and Treatment of Hepatocellular Carcinoma Complicated by Tumor Thrombus

A 50-year-old man with a 10-year history of hepatitis B and bilateral lower extremity edema (grade 3+) within the past two weeks, with no prior antiviral therapy, was reported. Physical examination of the abdomen suggested mild ascites. The patient had no history of smoking, and no family history of HCC was reported. Laboratory examinations revealed (2021/6/14): alanine aminotransferase 240 U/L, aspartate aminotransferase 192 U/L, albumin 38.8 g/L, urea 11.31 mmol/L, creatinine 132 µmol/L, alpha-fetoprotein 4.52 ng/mL, and carbohydrate antigen 125 64.7 U/mL; no other significant abnormalities were observed. As part of the examinations, he underwent abdominal enhanced computed tomography (CT), which revealed space-occupying lesions in the right liver lobe and hepatic vein/inferior vena cava tumor thrombus (HV/IVCTT) (Fig. 1). Combined with the patient’s history of hepatitis B and the form of enhancement, we considered the diagnosis of HCC complicated by HV/IVCTT. However, the IVC is not always enhanced, so the thrombus needs to be ruled out. With informed consent obtained from the patient, a segmental clamp biopsy of the IVC tumor thrombus was performed simultaneously during DEB-TACE (drug-eluting beads measuring 300–500 µm and loaded with 60 mg of tetrahydropyranyl were used for embolization) treatment.