Journal of Liver Cancer

Metastatic papillary renal cell carcinoma with portal vein tumor thrombosis confirmed on blind liver biopsy: Hun Kim, Tae Hoon Roh, Jun Seop Lee, Min Seong Kim, Beom Kyung Kim; J Liver Cancer. 2024;24(1):113-117. Published online November 29, 2023; DOI: https://doi.org/10.17998/jlc.2023.11.05

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Abstract PDF: Portal vein tumor thrombosis (PVTT) is an uncommon condition in which tumor cells expand into the vessels, causing blood clot formation in the portal vein. PVTT is mainly associated with hepatocellular carcinoma, leading to an unfavorable prognosis; however, it can also develop in patients with other cancer types. Herein, we report a case of metastatic renal cell carcinoma diagnosed by a blind liver biopsy in a patient with dynamic computed tomography-confirmed portal vein thrombosis and cholangiopathy. This case illustrates the importance of systematic surveillance with routine laboratory tests and contrast-enhanced imaging studies on patients with cancer to detect potential liver infiltration of metastatic cancer.

Complete response to local therapy for advanced hepatocellular carcinoma with lung metastasis: a case report: Daeun Kim, Seiyeon Park, Won Sohn, Hyun Pyo Hong, Byung Ik Kim; J Liver Cancer. 2022;22(1):51-56. Published online January 27, 2022; DOI: https://doi.org/10.17998/jlc.2021.12.28

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Abstract PDF: The concept of oligometastasis is widely accepted for various types of solid tumors; accordingly, better outcomes can be anticipated with aggressive local interventions. The treatment of advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is systemic therapy. However, treatment responses to systemic therapy are poor. Recently, a small number of metastatic cancers (oligometastasis) have been controlled by local therapy rather than systemic therapy. Our study reports a case of a 66-year-old male patient with advanced HCC with lung metastasis, which was treated with local therapy. There were less than four metastases in the lungs, which were treated with wedge resection, radiofrequency, and radiation therapy. He repeatedly underwent local therapy for lung oligometastasis and locoregional therapy for intrahepatic HCC rather than systemic therapy; control by local therapy was possible as his liver function was preserved with Child-Turcotte-Pugh class A.

Curative liver transplantation after lung resection for advanced hepatocellular carcinoma with lung metastasis and inferior vena cava tumor thrombosis: a case report: Dong Jin Joo, Do Young Kim, Jinsil Seong, Hyun Jeong Kim, Jae Geun Lee, Dai Hoon Han, Gi Hong Choi, Myoung Soo Kim, Jin Sub Choi, Soon Il Kim; J Liver Cancer. 2021;21(2):181-186. Published online September 30, 2021; DOI: https://doi.org/10.17998/jlc.2021.09.08

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Abstract PDF

Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.

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Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis
Raphael PH Meier, Shani Kamberi, Josue Alvarez-Casas, Barton F. Lane, Chandra S. Bhati, Saad Malik, William Twaddell, Kirti Shetty, Adam Fang, Hyun S. Kim, Daniel G. Maluf
Progress in Transplantation.2023;[Epub] CrossRef

Long-term survival after multimodal treatment involving radiotherapy for huge hepatocellular carcinoma with oligometastasis: a case report: Byung Min Lee, Jinsil Seong; J Liver Cancer. 2021;21(2):163-168. Published online September 2, 2021; DOI: https://doi.org/10.17998/jlc.2021.08.06

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Abstract PDF: The clinical efficacy of local ablative treatment for oligometastasis is widely accepted in most cancers. However, due to limited data, this has not been the case for hepatocellular carcinoma (HCC). Here, we report a case of pulmonary oligometastasis of a huge HCC that was treated by multimodality with liver-directed concurrent chemoradiotherapy (CCRT) plus subsequent resection of the primary lesion and local ablative radiotherapy (RT) for subsequent lung oligometastatic lesions. In this patient, liver-directed CCRT induced significant tumor shrinkage with compensatory hypertrophy of the non-tumor liver, followed by curative resection. Surgical resection of the first and second pulmonary metastatic lesions as well as local ablative RT of the third lesion achieved complete tumor regression, which led to long-term survival of 6 years. Therefore, the active use of local ablative RT requires full consideration in cases of oligometastatic HCC.

A Case of Metastatic Melanoma in the Liver Mimicking Hepatocellular Carcinoma: Jae-Kyoung So, Ji-Yun Hong, Min-Woo Chung, Sung-Bum Cho; J Liver Cancer. 2021;21(1):92-96. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.92

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The liver is one of the most common sites of metastasis. Although most metastatic liver cancers are hypovascular, some hypervascular metastases, such as those from melanoma, need to be differentiated from hepatocellular carcinoma (HCC) because they may show similar radiologic findings due to their hypervascularity. We encountered a case of multinodular liver masses with hyperenhancement during the arterial phase and washout during the portal venous and delayed phases, which were consistent with imaging hallmarks of HCC. The patient had a history of malignant melanoma and had undergone curative resection 11 years earlier. We performed a liver biopsy for pathologic confirmation, which revealed a metastatic melanoma of the liver. Metastatic liver cancer should be considered if a patient without chronic liver disease has a history of other primary malignancies, and caution should be exercised with hypervascular cancers that may mimic HCC.

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A case of metastatic melanoma in the liver mimicking colorectal cancer with synchronous liver metastasis
E.A. Warshowsky, M. McCarthy, K. Wells, A. Arcidiacono, L. Csury, J.R. Nitzkorski
International Journal of Surgery Case Reports.2024; 119: 109686. CrossRef

Rare Clinical and Radiologic Case of Cholangiocarcinoma Mimicking Pyogenic Abscess, Hepatic Echinococcal Cysts, and Metastases: Si Hyeong Lee, Soo Hyung Ryu, Dong Hoon Lee, Won Eui Yoon, Tae Young Park, Hye Kyung Lee, Jeong Seop Moon; J Liver Cancer. 2020;20(2):173-176. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.173

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Cholangiocarcinoma is a biliary carcinoma with a wide spectrum of imaging, histological, and clinical features. In immunocompromised patients, pyogenic abscesses are relatively common and an echinococcal hepatic cysts are very rare. The authors experienced a very rare case of cholangiocarcinoma showing multiple hypodense masses with wall enhancement mimicking pyogenic liver abscess, echinococcal hepatic cyst, and cystic metastases. An 83-year-old man, complaining of fatigue and poor oral intake, presented to our outpatient clinic. Abdominal computed tomography (CT) revealed multiple, variable-sized hypodense masses with peripheral rim enhancement throughout the liver. Dynamic liver magnetic resonance images also showed findings similar to those of a CT scan. We performed ultrasound-guided biopsy of the mass which revealed cholangiocarcinoma.

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Surgical strategy for incidental intrahepatic cholangiocarcinoma in terms of lymph node dissection
Sung Hyun Kim, Dai Hoon Han, Gi Hong Choi, Jin Sub Choi, Kyung Sik Kim
Journal of Gastrointestinal Surgery.2024;[Epub] CrossRef

Successful Sequential Therapy Involving Regorafenib after Failure of Sorafenib in a Patient with Recurrent Hepatocellular Carcinoma after Liver Transplantation: Soon Kyu Lee, Jeong Won Jang, Heechul Nam, Pil Soo Sung, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon; J Liver Cancer. 2020;20(1):84-89. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.84

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Abstract PDF: The efficacy and safety of sequential systemic therapy for the treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) are not well established. This study describes a successful experience where sequential therapy with sorafenib followed by regorafenib was used to treat recurrent HCC in a 54-year old male LT recipient. After HCC recurred in both lungs 10 months after LT, sorafenib was administered with radiation therapy to treat pulmonary metastases. However, after 4 months of sorafenib treatment showed progressive pulmonary metastases, sequential regorafenib treatment was started. After 3 months (cycles) of regorafenib treatment, tumor response was partial, and after 6 months (cycles), disease status remained stable without signs of progression or drug-related serious adverse events. This case suggests that sequential systemic therapy is feasible in patient with recurrent HCC after LT.

Nivolumab for Advanced Hepatocellular Carcinoma with Multiple Lung Metastases after Sorafenib Failure: Jaewoong Kim, Jin Won Chang, Jun Yong Park; J Liver Cancer. 2020;20(1):72-77. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.72

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Over the past decade, standard first-line systemic treatment of advanced hepatocellular carcinoma (HCC) has been based on sorafenib, a multi-kinase inhibitor. Regorafenib, another tyrosine kinase inhibitor, is the only second-line therapy that has been globally approved after progression under sorafenib treatment. Recently, immunotherapeutic agents have emerged as promising treatment options in many different malignancies, including advanced HCC. Nivolumab is the first immunotherapy approved by the Food and Drug Administration for use in HCC patients with advanced-stage second-line after sorafenib failure. In this report, a case of advanced HCC with multiple lung metastases in which a complete response and maintained progression-free status was achieved with nivolumab, following the failure of transarterial chemoembolization and sorafenib is presented. We hope this report may help expand the clinical application of second-line treatment.

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Infiltrative hepatocellular carcinoma with multiple lung metastasis completely cured using nivolumab: a case report
Ji Eun Han, Hyo Jung Cho, Soon Sun Kim, Jae Youn Cheong
Journal of Liver Cancer.2021; 21(2): 169. CrossRef

Combination Therapy of Angiotherapy, Radiation Therapy, and Radiofrequency Ablation for Pulmonary Metastasis of Hepatocellular Carcinoma Accompanied by Nontuberculous Mycobacteria: Sang Hyun Park, Seul Ki Kim, Ji Hye Kim, Seokgyo Seo, Hyun Pyo Hong, Soo-Youn Ham, Byung Ik Kim; J Liver Cancer. 2019;19(1):79-84. Published online March 31, 2019; DOI: https://doi.org/10.17998/jlc.19.1.79

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Abstract PDF: With the advances in hepatocellular carcinoma (HCC) treatment, the lung metastasis of HCC is becoming increasingly important. In treating the lung metastasis of HCC, a multidisciplinary approach can lead to better results than systemic chemotherapy alone. Here, we report on a patient who presented with pulmonary masses, while the HCC was being controlled in the abdominal cavity. The presence of nontuberculous mycobacteria was identified during the diagnosis of the pulmonary masses. The pulmonary metastases of HCC were treated with a combination of angiotherapy, radiation therapy, and radiofrequency ablation. The patient showed a satisfactory progress with this multidisciplinary localized treatment. We report the clinical progress and review the recent literature regarding the treatment of pulmonary metastasis without intrahepatic HCC herein.

Multiple Hepatic Metastasis and Lymphatic Metastasis of Solid Pseudopapillary Neoplasm of Pancreas: Kim, You Gyung , Kim, Byung Ik , Kim, Seul Ki , Kim, Hak Soo , Kim, Hong Ju , Cho, Yong Kyun , Jeon, Yu Gyu; J Liver Cancer. 2018;18(2):168-174. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.168

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Solid pseudo-papillary neoplasm (SPN) of pancreas is a rare epithelial neoplasm of pancreas with a low malignant potential, occurs most commonly in young females. Here, we report a rare case of woman who has severe hepatomegaly due to multiple hepatic metastases of SPN of pancreas. At the time of diagnosis, a SPN was detected at only pancreas and there was no evidence of metastasis. So, she received subtotal pancreatectomy and total splenectomy. After 2 years of follow up, multiple small hepatic metastases were presented. In spite of three times of radiofrequency ablation, the burden of hepatic metastasis has increased continuously and multiple intra-abdominal lymph nodes metastases were detected, and ascites and peripheral edema occurred. However, because of benign feature of SPN and extremely rare incidence of recurrence and metastasis, there is no specific treatment guideline for metastatic SPN. Through multidisciplinary care service, we planned to do radiotherapy followed by a transarterial chemoembolization (TACE). But the patient could not have a scheduled radiation therapy due to deterioration of liver function. So changing the strategy of treatment, followed by TACEs were done alone. Although the size of SPN is not reduced, the extent of SPN and complication of SPN (ascites, peripheral edema, abdominal pain and so on) are being controlled.

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Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases
Ravi Maharaj, Nahmorah J Bobb, Christo Cave, Keshan V Ramnarace, Jamar Critchlow
Cureus.2022;[Epub] CrossRef

A Case of Achieving Partial Remission with Sequential Treatment of Transarterial Chemoemoblization after Transarterial Radioembolization in Old Patient with Hepatocellular Carcinoma with Multiple Metastasis: Hwang, Sang Youn , Lee, Seon Mi , Im, Jung Woo , Jeon, Ki Jeong , Ahn, Sang Bu , Park, Jin Young; J Liver Cancer. 2018;18(2):151-156. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.151

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Abstract PDF: The number of older adults with hepatocelluar carcinoma (HCC) has been increasing with longer life expectancy and earlier diagnosis and treatment. However, older patients have lesser function reserve of multiple organ systems, more disability rate. Therefore, the treatment of elderly HCC patients remains a challenge worldwide. Recently, studies suggests that the survival outcome of older patients may be comparable to that of younger patients and active treatment may achieve promising rates of local and systemic control in selected patients. Based on above suggestions, we herein offer our experience of a case achieved partial remission by sequential therapy of transarterial chemoembolization after transarterial radioemoblization in elderly HCC patient with multiple metastasis. Further study, maybe regarding a combination of locoregional and systemic treatment, is necessary on how to manage HCC in elderly patients.

A Case of Abscopal Effect on Pulmonary Metastasis after Palliative Radiotherapy on Bone Metastasis of Hepatocellular Carcinoma: Do Seon Song, U Im Chang, Ho Jung An, Sung Hwan Kim, Jin Mo Yang; J Liver Cancer. 2017;17(2):168-173. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.168

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Abstract PDF: The abscopal effect is a rare phenomenon that characterized by tumor regression of untreated metastatic lesions after a local radiotherapy. The mechanisms of abscopal effect are speculated to be associated with cytokine release and host immune system. In this case, we report a case of abscopal effect in a 64-year-old male with hepatocellular carcinoma with lung and bone metastasis, who had complete response in the lung after receiving radiation to the metastatic bone lesions.

A Case of a Patient with Hepatocellular Carcinoma and Lung Metastasis Who Failed Sorafenib Treatment and Achieved Complete Remission after Lung Resection and Radiation Therapy: Jung Hwan Yu, Jung Il Lee; J Liver Cancer. 2017;17(1):77-81. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.77

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Abstract PDF: In hepatocellular carcinoma (HCC), sorafenib is the only approved systemic chemotherapy, and has been applied for those with advanced HCC especially with systemic metastasis. However, the treatment results are suboptimal leaving many cases with disease progression despite the use of optimum dose. There is no established guideline for those that fail to respond to sorafenib treatment. In this case, a 46-years-old male with metastatic lung cancer from HCC experienced progression despite sorafenib treatment. Then, the patient received surgical resection of the metastatic lung mass followed by radiation therapy and achieved complete remission for 10 months after the surgical treatment and radiation therapy. Alpha-fetoprotein level was normalized and complete remission has been maintained.

A Case of Hepatocellular Carcinoma with Pulmonary Metastasis Who Showed Complete Response by Cytotoxic Chemotherapy after Sorafenib Failure: Hwa-Sun Park, Jae Young Jang, Min Young Baek, Yong Kwon Kim, Hyun Jin Youn, Su Young Back, Soung Won Jeong, Sae Hwan Lee, Sang Gyune Kim, Sang Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim; J Liver Cancer. 2017;17(1):72-76. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.72

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Abstract PDF: Hepatocellular carcinoma (HCC) is the 2nd most common cause of cancer related death in Korea and well-known malignancy with poor prognosis. Sorafenib is the first-line molecular targeted agent in patients with extra-hepatic spread of HCC. However, complete response is extremely rare in patients treated with sorafenib and the disease control rate is only 43%. We report a 53-year-old man with advanced HCC with pulmonary metastasis who showed complete response by cytotoxic chemotherapy with doxorubicin and cisplatin with relatively tolerable adverse effects after failure of treatment with sorafenib.

Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Extrahepatic Metastasis: Jin Su Kim, Su Cheol Park; J Liver Cancer. 2016;16(2):82-85. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.82

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Abstract PDF: Transarterial chemoembolization (TACE) has been widely performed as a treatment for unresectable hepatocellular carcinoma (HCC). Recently extrahepatic metastasis (EHM) of HCC is increasing due to improvement of survival. Sorafenib has been generally accepted as a standard treatment in advanced HCC. However, many HCC patients with EHM are treated with TACE in real-world clinical practice because sorafenib has modest efficacy and the main cause of death in the patients with EHM is hepatic failure. In this review, the usefulness of TACE for the patients with HCC and EHM will be discussed.

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