Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report
Abstract Background Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after a...
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Japan Surgical Society
2020-09-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00985-9 |
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| author | Takashi Maeda Daisuke Imai Huanlin Wang Kyohei Yugawa Nao Kinjo Koto Kawata Shinichiro Ikeda Keitaro Edahiro Kazuki Takeishi Tomohiro Iguchi Hiroto Kayashima Noboru Harada Mizuki Ninomiya Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda |
| author_facet | Takashi Maeda Daisuke Imai Huanlin Wang Kyohei Yugawa Nao Kinjo Koto Kawata Shinichiro Ikeda Keitaro Edahiro Kazuki Takeishi Tomohiro Iguchi Hiroto Kayashima Noboru Harada Mizuki Ninomiya Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda |
| author_sort | Takashi Maeda |
| collection | DOAJ |
| description | Abstract Background Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion. Case presentation A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits. Conclusions Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family. |
| format | Article |
| id | doaj-art-1d71ac79e3b744988e5bc583154e12e8 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-1d71ac79e3b744988e5bc583154e12e82025-08-20T03:32:52ZengJapan Surgical SocietySurgical Case Reports2198-77932020-09-01611510.1186/s40792-020-00985-9Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case reportTakashi Maeda0Daisuke Imai1Huanlin Wang2Kyohei Yugawa3Nao Kinjo4Koto Kawata5Shinichiro Ikeda6Keitaro Edahiro7Kazuki Takeishi8Tomohiro Iguchi9Hiroto Kayashima10Noboru Harada11Mizuki Ninomiya12Shohei Yamaguchi13Kozo Konishi14Shinichi Tsutsui15Hiroyuki Matsuda16Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalAbstract Background Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion. Case presentation A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits. Conclusions Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family.http://link.springer.com/article/10.1186/s40792-020-00985-9Hepatocellular carcinomaPregnancyHepatic resection |
| spellingShingle | Takashi Maeda Daisuke Imai Huanlin Wang Kyohei Yugawa Nao Kinjo Koto Kawata Shinichiro Ikeda Keitaro Edahiro Kazuki Takeishi Tomohiro Iguchi Hiroto Kayashima Noboru Harada Mizuki Ninomiya Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report Surgical Case Reports Hepatocellular carcinoma Pregnancy Hepatic resection |
| title | Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report |
| title_full | Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report |
| title_fullStr | Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report |
| title_full_unstemmed | Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report |
| title_short | Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report |
| title_sort | hepatic resection for recurrent hepatocellular carcinoma during pregnancy a case report |
| topic | Hepatocellular carcinoma Pregnancy Hepatic resection |
| url | http://link.springer.com/article/10.1186/s40792-020-00985-9 |
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