A Patient with multiple hepatocellular carcinoma with portal vein tumor thrombosis

Yuta Imai 1, Taiga Koyama 1, Hiroyuki Mishima 2, Takuzo Nanbu 2, Masahiro Yamamoto 3, Toshiyuki Tsujioka 3, Hiroyuki Sugihara 4

1 Junior Resident, Kohka Public Hospital
2 Department of Internal Medicine, Kohka Public Hospital
3 Department of Central Clinical Laboratory, Kohka Public Hospital
4 Department of Pathology, Shiga University of Medical Science

 The patient, who was a male in his 70’s, had received treatment for hypertension and diabetes for several years in the outpatient of our hospital. The patient had dysorexia and abdominal distention in January 200X. In March, hematological examination revealed hepatic insufficiency. The patient used to be a heavier drinker. Markers for hepatitis B and C viruses were negative. The patient was diagnosed with hepatocellular carcinoma accompanied by portal vein tumor thrombosis by abdominal CT, but he was discharged from the hospital to receive treatment at home because the carcinoma was in the terminal stage. Since malaise was aggravated, the patient was readmitted in April, and died the next day. Multiple hepatocellular carcinoma was confirmed by autopsy. It was found that this carcinoma had developed from alcoholic hepatitis, and the cause of the rapid death was ischemic necrosis of the residual liver, which aggravated hepatic insufficiency due to multiple hepatocellular carcinoma and portal vein thrombosis. The hepatic ischemia was due to circulatory insufficiency caused by gastric hemorrhage. There was multiple organ failure including nonhepatic organ insufficiency that was accompanied by aspiration of the gastric contents. We discuss the relationship between alcoholic liver injury and hepatic carcinoma.

Key words: alcohol, hepatocellular carcinoma, portal vein tumor thrombosis