Drug-eluting beads in hepatocellular carcinoma.

A 72-year-old Japanese man was diagnosed with multiple hepatocellular carcinomas (HCCs) and treated with transcatheter arterial embolization using drug-eluting beads (DEB-TACE). Figure 1 shows dynamic computed tomography (CT) before DEB-TACE. White arrows show tumor stain of 75 mm HCC in the left liver lobe and was well embolized by DEB-TACE using beads with diameter of 500–700 µm resulted in the disappearance of tumor stain in the majority of the tumor (white arrowhead in Figure 2), although remaining tumor stain was evidenced in its edge (black arrow in Figure 2). He died of pneumonia 3 months after DEB-TACE and autopsy was performed to examine the antitumor effect of DEB-TACE on the tumor and the potential damage in the other lesions of the liver by pathologically examining the entire liver. Macroscopic image of the entire liver showed multiple HCCs and the DEB-TACE-treated tumor showed: (1) beads itself in the tumor (black arrowheads in Figure 3) and the tumor feeding artery (white arrows in Figure 3); its necrotic changes (white arrowheads in Figure 3); and remaining of the viable tumor (black arrow in Figure 3) consistent with CT images (Figure 2). Microscopic findings of hematoxylin and eosin staining demonstrated successful embolization that was evidenced by necrosis (white arrowheads in Figure 4) and the presence of the beads in the tumor feeder (black arrowheads in Figure 4), although the remaining tumor cells were histologically diagnosed with tubular and poorly differentiated adenocarcinoma (black arrow in the inset of Figure 4). Importantly, no migration was confirmed in the other lesions of the liver nor other organs including lung, heart, spleen, and kidneys. This is the rare report to show a clear image of HCC and its feeding artery that were well embolized by DEB-TACE and confirmed no migration into the other organs by autopsy. The number of HCC cases treated with DEB-TACE is increasing based on the safety and efficiency evidenced in the clinical trials[1,2] and it is reported that the release of the cytotoxic drug in a controlled fashion into the tumor, inflicting local ischemia while reducing systemic drug concentrations.[3,4] However, to date there is no report showing the pathological analysis of entire liver with HCC treated with DEB-TACE. Our case showed well embolization of tumors with feeding arteries consistent with the CT image and no migration of beads into the other organs or part of the liver, showing the safety of DEB-TACE. This report provides physicians with clear evidence regarding the safety and efficiency of treating HCC with DEB-TACE.

Figure 1.

Dynamic computed tomography before treatment. White arrow represents the tumor stain.

Figure 2.

Dynamic computed tomography after DEB-TACE. Necrotic change (White arrowhead) and remaining tumor stain (Black arrow) were seen.

Figure 3.

Macroscopic image of HCC treated with DEB-TACE. The black arrowheads and white arrows indicate the beads in the tumor and embolized hepatic artery, respectively. White arrowheads indicate the necrotic lesions in the tumor. Black arrow indicates the remaining tumor.

Figure 4.

Microscopic findings of hematoxylin and eosin staining of HCC embolized by DEB-TACE. White and black arrowheads represent the necrosis and presence of the beads in the tumor feeder, respectively. Black arrow indicates the remaining tumor cells (inset).