American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2021, 9(9), 441-444
DOI: 10.12691/ajmcr-9-9-2
Open AccessCase Report

Complicated HCC - A Case of IVC Thrombosis

Ismail Malik1, , Ibrahim Omore1, Kesiena Akpoigbe1, Abimbola Fadairo-Azinge1 and Luqman Salahudeen1

1Department of Internal Medicine, NYC Health & Hospitals (Harlem), New York, USA

Pub. Date: May 17, 2021

Cite this paper:
Ismail Malik, Ibrahim Omore, Kesiena Akpoigbe, Abimbola Fadairo-Azinge and Luqman Salahudeen. Complicated HCC - A Case of IVC Thrombosis. American Journal of Medical Case Reports. 2021; 9(9):441-444. doi: 10.12691/ajmcr-9-9-2


Hepatocellular cancer (HCC) is known to be among one of the commonest primary liver tumors globally with rising incidence and it is often implicated as a frequent cause of cancer-related death. It usually carries a poor prognosis because it is not often diagnosed early until the advanced stages of the disease with distant metastatic spread, vascular invasion, and thrombus formation. The pathophysiologic evolution of HCC is complicated involving prolonged inflammatory damage with sequelae of hepatocyte necrosis, regeneration, and fibrosis. Involvement of the vasculature portends a dismal outcome (less than 6 month survival) although inferior vena cava (IVC) tumor thrombus occur far less commonly than portal and hepatic veins. This can present a significant challenge in patient management despite advances in diagnostic and therapeutic modalities, due to late clinical presentation and lack of consensus regarding treatment. We report a 71-year old man who presented with syncope with incidental finding of large hepatocellular cancer with IVC thrombosis. Following extensive workup, the patient was ineligible for surgical intervention and was referred for chemoembolization with possible immunotherapy. This case highlights vigilance for occult malignant processes in patients that may present atypically.

hepatocellular carcinoma inferior vena cava thrombus syncope hepatitis trans-arterial chemoembolization

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[1]  Rawla P, Sunkara T, Muralidharan P, Raj JP. Update in global trends and aetiology of hepatocellular carcinoma. Contemp Oncol. 2018; 22(3):141-150.
[2]  Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394-424.
[3]  Younossi Z, Stepanova M, Ong JP, Jacobson IM, Bugianesi E, Duseja A, Eguchi Y, Wong VW, Negro F, Yilmaz Y, Romero-Gomez M, George J, Ahmed A, Wong R, Younossi I, Ziayee M, Afendy A; Global Nonalcoholic Steatohepatitis Council. Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates. Clin Gastroenterol Hepatol. 2019 Mar; 17(4): 748-755.e3.
[4]  Pao TH, Hsueh WT, Chang WL, et al. Radiotherapy for inferior vena cava tumor thrombus in patients with hepatocellular carcinoma. BMC Cancer. 2019; 19(1): 560.
[5]  Quencer KB, Friedman T, Sheth R, Oklu R. Tumor thrombus: incidence, imaging, prognosis and treatment. Cardiovasc Diagn Ther. 2017 Dec; 7(Suppl 3): S165-S177.
[6]  Kokudo T, Hasegawa K, Yamamoto S, Shindoh J, Takemura N, Aoki T, Sakamoto Y, Makuuchi M, Sugawara Y, Kokudo N. Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis. J Hepatol. 2014 Sep; 61(3): 583-8.
[7]  Sakamoto K, Nagano H. Outcomes of surgery for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium. Surg Today. 2018; 48(9): 819-824.
[8]  Sa├»sse J, Hardwigsen J, Castellani P, Caus T, Le Treut YP. Budd-Chiari syndrome secondary to intracardiac extension of hepatocellular carcinoma. Two cases treated by radical resection. Hepatogastroenterology. 2001 May-Jun; 48(39): 836-9. PMID: 11462935.
[9]  Rossi S, Ghittoni G, Ravetta V, et al. Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol. 2008; 18(8): 1749-1756.
[10]  Pawlik TM, Poon RT, Abdalla EK, et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery. 2005; 137(4): 403-410.
[11]  Wang Y, Yuan L, Ge RL, Sun Y, Wei G. Survival Benefit of Surgical Treatment for Hepatocellular Carcinoma with Inferior Vena Cava/Right Atrium Tumor Thrombus: Results of a Retrospective Cohort Study. Ann Surg Oncol. 2012; 20(3): 914-922.
[12]  Yogita S, Tashiro S, Harada M, Kitagawa T, Kato I. Hepatocellular carcinoma with extension into the right atrium: report of a successful liver resection by hepatic vascular exclusion using cardiopulmonary bypass. J Med Invest. 2000 Aug; 47(3-4): 155-60. PMID: 11019497.
[13]  Rimassa L, Pressiani T, Merle P. Systemic Treatment Options in Hepatocellular Carcinoma. Liver Cancer. 2019; 8(6): 427-446.
[14]  Bouattour M, Mehta N, He AR, Cohen EI, Nault JC. Systemic Treatment for Advanced Hepatocellular Carcinoma. Liver Cancer. 2019; 8(5): 341.
[15]  Raoul JL, Frenel JS, Raimbourg J, Gilabert M. Current options and future possibilities for the systemic treatment of hepatocellular carcinoma. Hepatic Oncology. 2019; 6(1).