Case Reports in Oncology (Nov 2014)

Delayed Intratumoral Hemorrhage after Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

  • Kazue Shiozawa,
  • Manabu Watanabe,
  • Takashi Ikehara,
  • Yu Ogino,
  • Tomoko Umakoshi,
  • Yasushi Matsukiyo,
  • Michio Kogame,
  • Teppei Matsui,
  • Yoshinori Kikuchi,
  • Yoshinori Igarashi,
  • Yasukiyo Sumino

DOI
https://doi.org/10.1159/000369005
Journal volume & issue
Vol. 7, no. 3
pp. 739 – 745

Abstract

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Transarterial chemoembolization (TACE) using a drug-eluting bead (DEB-TACE) for hepatocellular carcinoma (HCC) is a new treatment method. We report on a case of delayed intratumoral hemorrhage after DEB-TACE. An 81-year-old male with hepatitis C virus-related cirrhosis was diagnosed with a HCC of 35 mm in diameter in S5 detected by dynamic computed tomography (CT) and contrast-enhanced ultrasonography (CEUS). DEB-TACE with DC Bead® and epirubicin hydrochloride was performed because the patient declined to undergo surgical resection. The treatment was completed, and the course after DEB-TACE was favorable. However, right hypochondriac pain suddenly developed about 1 month after DEB-TACE. Unenhanced CT showed an increase of the tumor diameter and intratumoral high-intensity area, which was not enhanced in the arterial phase. CEUS performed at the time of right hypochondriac pain (5 weeks after DEB-TACE) showed nonenhancement of almost the entire tumor in the vascular phase. The cause of the symptom may have been DEB-TACE-associated intratumoral hemorrhage. Tumor hemorrhage has been reported after DEB-TACE with tumors >5 cm in diameter, and the tumor locations were subcapsular in all previous reports. There has been no case of a tumor with a diameter <5 cm distinct from the subcapsular, as was observed in our patient. Incomplete embolization might be the cause of the intratumoral hemorrhage experienced by this case presenting a few risks. To obtain the therapeutic effect of DEB-TACE while preventing the adverse events, it may be important to understand the characteristics of the beads and to apply the appropriate embolization to each individual case.

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