Multifocal Hepatocellular Carcinoma Extending into the Right Atrium: A Report of Two Cases

Abstract

Hepatocellular Carcinoma (HCC) is one of the most aggressive malignant tumours, frequently inducing macrovascular invasion. Tumoural Thrombus (TT) production in mature HCC stages is prevalent and typically affects the hepatic or portal veins. Hereby, the authors present a case report of two cases, firstly, 68-year-old male who presented to the Emergency Department with bilateral pedal oedema and a lack of appetite; secondly, 62-year-old female who reported with weakness and giddiness for two months, abdominal distention for one month, black-coloured stools for one month, and a two-month history of weight loss. Abdominal Computed Tomography (CT) scans for both patients revealed multiple ill-defined solid lesions with necrotic foci in the liver in the former case, and multiple heterogeneously enhancing lesions with a few calcific foci and haemorrhages in the liver in the latter patient, consistent with HCC and tumoural thrombus extending from the hepatic vein into the Right Atrium (RA) via the Inferior Vena Cava (IVC). HCC with TT spreading into the RA is a serious and challenging condition with a poor prognosis. Early detection and aggressive treatment are critical, but they are typically insufficient to prevent rapid disease progression and high mortality.

Keywords

• alpha-fetoprotein
• inferior vena cava
• necrotic foci
• tumoural thrombosis