Primary liver carcinoma complicating membranous obstruction of the inferior vena cava.

A rare autopsy case of primary liver carcinoma complicating a pre-existing, incomplete membranous obstruction of the inferior vena cava (MOVC) is reported. The patient, a 67-year-old Japanese male, was admitted to hospital following a 2 year illness of a left chest wall tumor and a 3 month illness with progressive abdominal pain. Computed tomography scans of the abdomen displayed space-occupying lesions in the third and seventh hepatic segments, respectively. One month later, the patient developed edema of the lower extremities and marked venous dilatation of the abdominal trunk. At that time, Doppler examination revealed the presence of intrahepatic large venovenous collaterals. The patient subsequently succumbed 82 days after hospitalization. At subsequent autopsy, the inferior vena cava was completely obstructed by tumor thrombus, which was formed caudally and cranially to a thin membrane and mimicked the valve, with calcification and elastic lamina, at the phrenic portion. Intrahepatic large collateral pathways were found between submembranous and supramembranous hepatic veins. Anomalous absence of the ostia of the middle hepatic vein was found. In addition, the portal venous trunk was occluded by tumor thrombus. Histology of hepatic tumors revealed a combined hepatocellular and cholangiocellular carcinoma in the non-cirrhotic liver with severe acute centrilobular congestion. In MOVC patients such as the case presented, malignancy-induced thrombosis was deemed to be an important factor in prognosis.