[Morphologic verification of neoplastic portal vein obstruction]

Tumourous invasion into the portal circulation is a frequent and typical complication of primary carcinoma of the liver. No imaging method can, however, assess unequivocally the biological nature of the vascular occlusion and rule out reliably the possibility of benign thrombosis. The objective of the present work was to evaluate the yields of percutaneous thin-needle aspiration biopsy for the verification of intraluminal growth of a tumour, which influences to a considerable extent decisions and possible subsequent therapeutic provisions.

Aspiration biopsy of the thrombus was performed in 33 patients with an ultrasonographically apparent occlusion of the portal circulation associated in 29 observations with primary carcinoma of the liver and in four instances with secondaries in the liver. For puncture thin needles--0.8-0.9 mm (21-20 G) were used inserted under ultrasonographic control. The presence of tumourous cells in the portal vessels was proved in 31 patients, i.e. in 94%. An oncologically negative result of biopsy was recorded in one patient with primary carcinoma of the liver and in a female patient with secondaries. Among morphologically verified tumourous occlusions complicating primary carcinoma of the liver a multinodular variant of a tumour was found in 11 observations and a solitary form (mean size of the focus 9 cm) in 10 observations. In 7 patients the vascular occlusion and positive result of biopsy revealed the existence of a diffuse infiltrating type of tumour. In the histological structure of the tumour which was assessed in 13 primary carcinomas of the liver differentiated types of neoplasms predominated unequivocally (10 cases) over non-differentiated tumours (3 cases).

Thin-needle aspiration biopsy is a highly sensitive method for the detection of vascular expansion of liver tumours. It can be used successfully and without risk to assess staging of the disease where necessary.