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Extrahepatic metastasis of hepatocellular carcinoma to the paravertebral muscle:A case report

World Journal of Hepatology 2017年第22期9卷 973-978页

作者： Kazuhiro Takahashi krishna g putchakayala Mohamed Safwan Dean Y Kim Transplant and Hepatobiliary Surgery Henry Ford HospitalDetroitMI 48202United States

Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.

关键词： Hepatocellular carcinoma Skeletal muscle Paravertebral muscle Extrahepatic metastasis Stereotactic hypo-fractionated image guided radiation therapy Hepatitis B virus

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Allograft loss from acute Page kidney secondary to trauma after kidney transplantation

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World Journal of Transplantation 2017年第1期7卷 88-93页

作者： Kazuhiro Takahashi Rohini Prashar krishna g putchakayala William J Kane Jason E Denny Dean Y Kim Lauren E Malinzak Transplant and Hepatobiliary Surgery Henry Ford Hospital Nephrology and Internal Medicine Henry Ford Hospital

We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria. His serum creatinine level was slightly elevated from his baseline. Computer tomography revealed a large subscapular hematoma around the transplant kidney. The patient was observed to have renal trauma grade Ⅱ at the hospital over a period of three days, and he was finally transferred to a transplant center after his urine output significantly decreased. Doppler ultrasound demonstrated an extensive peri-allograft hypoechoic area and abnormal waveforms with absent arterial diastolic flow and a patent renal vein. Despite surgical decompression, the allograft failed to respond appropriately due to the delay in surgical intervention. This is the third reported case of allograft loss from acute Page kidney following kidney transplantation. This case reinforces that kidney care differs if the kidney is solitary or a transplant. Early recognition and aggressive treatments are mandatory, especially in a case with Doppler signs that are suggestive of compression.

关键词： Page kidney Kidney transplantation Trauma Subcapsular hematoma Doppler ultrasound

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