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HEPATECTOMY AFTER CHEMOEMBOLIZATION WITH COMPLETE PATHOLOGIC RESPONSE: CASE REPORT
Apresentação do caso
Female patient, 54 years old, with no history of hepatitis or alcoholism and immunized against hepatitis B. In outpatient follow-up with a complaint of epigastric pain for 4 months, she underwent magnetic resonance imaging that showed a well-defined oval nodule in liver segment II, 7.0 x 5.0 cm, with displacement of the hepatic vein, without tissue invasion or thrombosis with a non-conclusive diagnosis, but with a hypothesis of hepatocarcinoma and hemangioma, serially, she underwent laboratory tests with markers alpha-fetoprotein 5.7 ng/mL; CA 125 9.4 U/mL; and CA 19-9 26 U/mL. After liver biopsy diagnosed hepatocarcinoma, secondary to nonalcoholic steatohepatitis according to personal history of obesity and steatosis, transarterial chemoembolization with doxuribicin 50 mg in a single nodule in the left hepatic lobe was proposed. It was then performed hepatectomy with satisfactory clinical evolution and anatomopathological study of the excision that showed granulomatous reaction to intravascular inorganic microspheres with necrosis without viable lesion and with free margins, concluding complete pathological response after chemotherapy treatment. Subsequent 20 days, MRI revealed absence of neoplastic liver lesion and presence of steatosis.
The hepatocarcinoma is the primary liver neoplasm with the highest incidence in the world and has as risk factors, especially nonalcoholic steatohepatitis and infection with hepatitis B and C viruses. Even with health promotion actions, many patients are diagnosed late, making treatment difficult. Among the procedures, there is the transarterial chemoembolization, which causes prolonged ischemia of the tumor tissue, indicated for those who would not support radical interventions or in cases of non-resectability. Moreover, this technique can be used as a bridging treatment, aiming to reduce the size of the lesion to later adhere to surgery, as in the clinical case presented. Thus, this intervention provided tumor reduction, release of the shared venous area, and decreased morbidity and mortality in the surgical procedure.
Therefore, transarterial chemoembolization as a single therapy, despite not being resolutive in all episodes, may present itself as an allied tool in more complex cases, thus collaborating to therapeutic success.
Hepatocarcinoma; Chemoembolization; Hepatectomy.
Fígado / Pâncreas / Vias Biliares
CAIO DE CARVALHO ZANON, FABIO ARNONI PINTO, BRUNO REIS PERUZZA, RAFAELA MORENO, BRUNA REGINA OLIVEIRA MARTINS, NATHALIE ABDALLAH ZAHALAN, RAFAELLA FIQUENE DE BRITO FILGUEIRA, BRUNO FIGUEIREDO MULLER, NAM JIN KIM, TIAGO RIUJI IJICHI