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Hepatocellular carcinoma with intra-atrial tumor growth. A clinicopathologic study of 18 autopsy cases
Insights
Hepatocellular carcinoma (HCC) can invade the heart, causing severe symptoms like edema. This autopsy study examined 18 HCC cases with intra-atrial tumor growth, revealing common venous and cardiac involvement.
Area of Science:
- Oncology
- Pathology
- Cardiology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer.
- Intra-atrial tumor extension from HCC is a rare but serious complication.
- Understanding the pathological features and clinical implications is crucial for patient management.
Purpose of the Study:
- To investigate the pathological characteristics of hepatocellular carcinoma (HCC) with intra-atrial tumor growth.
- To identify associated clinical and macroscopic features in these cases.
Main Methods:
- Retrospective autopsy study of 439 cases of HCC.
- Detailed examination of 18 cases exhibiting intra-atrial tumor involvement.
- Macroscopic and pathological analysis of tumor growth patterns and extent.
Main Results:
- 18 cases of HCC with intra-atrial tumor growth were identified (4.1% of HCC autopsy cases).
- Common findings included marked lower extremity edema (77.7%) and abdominal wall venous dilatation (27.7%).
- Tumor thrombi frequently involved the right atrium, inferior vena cava (IVC), and hepatic veins (15 cases), with 5 cases showing tricuspid valve crossing.
Conclusions:
- Intra-atrial tumor growth in HCC is associated with significant systemic venous congestion and cardiac involvement.
- The infiltrative or mixed growth pattern is common in these advanced cases.
- Early recognition of these features is vital for palliative care and understanding prognosis.
Abstract:
We studied the features of 18 cases of hepatocellular carcinoma (HCC) with prominent intra-atrial tumor growth that were seen among 439 autopsy cases of HCC. Diuretic-resistant, marked edema in the lower extremities and marked venous dilatation in the abdominal wall were observed in 14 cases (77.7%) and five cases (27.7%), respectively. Consistent tachycardia was seen in three cases. Macroscopically, most of the cases showed an infiltrative or mixed (infiltrative and nodular) growth pattern. A continuous tumor thrombus involving the right atrium, the IVC, and the hepatic vein was seen in 15 cases; a tumor that involved the right atrium alone was present in three cases. In five cases, the tumor bolus crossed the tricuspid valve and entered the ventricle.