Case Description
The patient is a 38-year-old female who initially presented in July 2015 with continuous abdominal pain radiating to her back as well as diarrhea, lightheadedness, and flushing. CT of the abdomen demonstrated multiple hepatic lesions. A percutaneous liver mass biopsy was performed confirming the diagnosis of well-differentiated neuroendocrine tumor. Subsequent PET CT showed FDG-avid lesions throughout the right and left hepatic lobe, the largest conglomerate of tumors measuring 10cm in the left lateral segment. Despite optimizing medical therapy Sandostatin, the patient was experiencing persistent symptoms. She was considered a candidate for bilobar radioembolization, which she underwent in October and November of 2016. Following radioembolization, her symptoms initially improved but then relapsed. Follow up CT of the abdomen demonstrated slight intrahepatic progression with the left lateral hepatic mass increasing in size from 12.8 x 7.0cm to 13.3 x 7.7cm. The images below include the most recent CT showing the left hepatic mass as well as the pre- and post-chemoembolization angiogram images.
Contrast-enhanced CT image demonstrating a large left hepatic metastatic neuroendocrine tumor.
Left hepatic angiogram through a microcatheter demonstrating the hypervascular mass.
Selective chemoembolization of the left lateral hepatic mass was performed. Chemoembolization via a right common femoral approach was utilized. A Hi-Flo Renegade microcatheter and Fathom microwire were used to select the arterial branches supplying the dominant hypervascular segment 2/3 mass and selective chemoembolization with 100-300 um LC Beads with 75 mg of Doxorubicin was performed.
Subselective catheterization of a left hepatic branch supplying the tumor.
Post-embolization angiogram demonstrating successful embolization of the branches supplying the tumor.
The patient did experience mild nausea and pain following the procedure which was managed with an observational stay overnight in order to provide intravenous medications. She was discharged the following morning.