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-Case Reports-
Major Arterioportal Shunt Caused by Hepatocellular Carcinoma
1Surgery for Organ Function and Biological Regulation, Graduate School of Medinine, Nippon Medical School
2Department of Integrative Pathology, Graduate School of Medinine, Nippon Medical School
A case of hepatocellular carcinoma (HCC) causing a major arterioportal (A-P) shunt is reported. The patient exhibited massive ascites and tested positive for hepatitis B surface antigen. An abdominal computed tomography (CT) examination showed a low-density lesion in the left lobe of the liver and an A-P shunt, but no tumor stain was visible. Upper gastrointestinal endoscopy revealed severe esophageal varices. Because the tumor marker level was abnormally high, an HCC causing an A-P shunt in a cirrhotic liver background with severe esophageal varices as a result of portal hypertension was diagnosed. We performed endoscopic variceal ligation to treat the severe esophageal varices and interventional radiology treatment for the A-P shunt and HCC, but the patient's condition was unchanged. Because the patient's liver function gradually improved, surgical treatment was selected. The patient underwent left hepatectomy. Pathological examination revealed a poorly differentiated HCC in a cirrhotic liver background. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation.The patient subsequently underwent transcatheter arterial embolization therapy for recurrent HCC in the right lobe of the liver, but the esophageal varices disappeared.
J Nippon Med Sch 2007; 74: 314-318
Keywords
hepatocellular carcinoma, arterioportal shunt, esophageal varices
Correspondence to
Yasuhiro Mamada, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
mamachan@nms.ac.jp
Received, April 4, 2007
Accepted, May 14, 2007
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