Hepatocellular carcinoma （HCC） recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in...Hepatocellular carcinoma （HCC） recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemoembolization （TACE）, radiofrequency ablation （RFA）, ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma. Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results. Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres （SIR-Spheres, Sirtex Medical Inc., Lake Forest, IL, USA）. Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein （AFP） level. There were no adverse consequences of initial treatment.展开更多
Abdominal pain with elevated transaminases from inferior vena cava(IVC)obstruction is a relatively common reason for referral and further workup by a hepatologist.The differential for the cause of IVC obstruction is e...Abdominal pain with elevated transaminases from inferior vena cava(IVC)obstruction is a relatively common reason for referral and further workup by a hepatologist.The differential for the cause of IVC obstruction is extensive,and the most common etiologies include clotting disorders or recent trauma.In some situations the common etiologies have been ruled out,and the underlying process for the patient's symptoms is still not explained.We present one unique case of abdominal pain and hepatomegaly secondary to IVC constriction from extrinsic compression of the diaphragm.Based on this patient's presentation,we urge that physicians be cognizant of the IVC diameter and consider extrinsic compression as a contributor to the patient's symptoms.If IVC compression from the diaphragm is confirmed,early referral to vascular surgery is strongly advised for further surgical intervention.展开更多
文摘Hepatocellular carcinoma （HCC） recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemoembolization （TACE）, radiofrequency ablation （RFA）, ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma. Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results. Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres （SIR-Spheres, Sirtex Medical Inc., Lake Forest, IL, USA）. Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein （AFP） level. There were no adverse consequences of initial treatment.
文摘Abdominal pain with elevated transaminases from inferior vena cava(IVC)obstruction is a relatively common reason for referral and further workup by a hepatologist.The differential for the cause of IVC obstruction is extensive,and the most common etiologies include clotting disorders or recent trauma.In some situations the common etiologies have been ruled out,and the underlying process for the patient's symptoms is still not explained.We present one unique case of abdominal pain and hepatomegaly secondary to IVC constriction from extrinsic compression of the diaphragm.Based on this patient's presentation,we urge that physicians be cognizant of the IVC diameter and consider extrinsic compression as a contributor to the patient's symptoms.If IVC compression from the diaphragm is confirmed,early referral to vascular surgery is strongly advised for further surgical intervention.
