Pathomorphological and Angiographic Studies on Intrahepatic Metastasis of Hepatocellular Carcinoma -With Special Reference to Efferent Vessel of the Tumor-

Akihiro Toyosaka, Eizo Okamoto, Tatsuo Okasora, Naoki Yamanaka, Masao Mitsunobu, Takeshi Oriyama, Jiro Fujimoto

First Department of Surgery, Hyogo College of Medicine

The mecahnism of intrahepatic metastasis in hepatocellular carcinoma (HCC) was investigated, based on pathomorphological and angiographic studies of 393 resected specimens. At the time of the operation, extrahepatic metastasis of HCC is extremely rare. However, intrahepatic metastasis was found at the high rate of over 90% in HCCs more than 5 cm in diameter. The intrahepatic metastasis was closely related to portal vein thrombosis, with multiple metastatic nodules in the portal area, in which a tumor thrombus was present. A rich vascular network was seen mainly in the capsule around the tumor, and communication between this vascular channel in the capsule and blood space into the tumor was detected by fine communicating vessels or directly. Tumor thrombi flowing out from the blood space in the tumor to vascular channels in the tumor capsule through the fine communicating vessels were frequently observed. When a radiopaque material was injected directly into the resected tumors, most of it entered the portal vein through vascular channels in the capsule. When a radiopaque medium was percutaneously injected into the tumors of patients with unresectable lesions, it similarly flowed out into the portal vein. These findings suggest that the feeding vessel is entirely the hepatic artery and that the portal vein plays mainly a role as the efferent vessel. It was considered that this was the reason why portal vein thrombosis and intrahepatic metastasis in HCC occurred at a high rate.

Key words
hepatocellular carcinoma, intrahepatic metastasis, drainage vessel of hepatocellular carcinoma

Reprint requests
Akihiro Toyosaka First Department of Surgery, Hyogo College of Medicine
1-1 Mukogawa-cho, Nishinomiya, 663 JAPAN

Accepted
November 19, 1990

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