Intra-Atrial Tumor Invasion in Hepatocellular Carcinoma

Abstract

When HCC affects the venous system, it is not uncommon for a tumor thrombus to extend to the hepatic vein or inferior vena cava. Occasionally, such extension results in Budd-Chiari syndrome secondary to HCC [124, 125]. Ball-valve thrombus syndrome following an intra-atrial tumor growth has been described in some cases where sudden death ensued from extension of the tumor invasion into the right atrium [126]. Although extension of the tumor thrombus to the inferior vena cava and/or right atrium is first disclosed at autopsy in most cases, there are some cases in which the intra-atrial tumor growth could have been diagnosed by echocardiography or angiography 3–4 months prior to death. According to a survey of 78 cases of tumor thrombus in the inferior vena cava by Simpson [127], the tumor thrombus most commonly originated in malignancies of the kidney or adrenal gland; a tumor thrombus secondary to HCC was noted in only seven cases. According to Gustafson [128], of 62 cases of HCC, two had a tumor thrombus in the inferior vena cava extending into the right atrium. According to Gregory [129], of 234 cases of HCC described in the literature, only six had a tumor thrombus in the inferior vena cava or right atrium. Edmondson and Steiner [9] encountered a tumor thrombus of the hepatic vein in 11 of 100 cases of HCC. The tumor thrombus had extended up to the inferior vena cava in seven and the right atrium in one of the eleven cases. According to MacDonald [130], the thrombus extended into the inferior vena cava or right atrium in 3 of 108 cases of HCC.