The Role of CEUS in the diagnosis of a rare case of HCC and spleen metastases

Eugenia Laura Lucan 1, Ioana Andreea Gheonea2, Ștefan Cristian Dinescu1, Sarmis Marian Săndulescu 3 , Roxana Mihaela Dumitrașcu1, Mihaela Stănciugel1 , Tudorel Ciurea4 , Larisa Daniela Săndulescu 1,4

1 Department of Internal Medicine, Emergency County Hospital Craiova, Romania, 2 Radiology and Imaging Department, County Hospital Craiova , Romania, 3 Surgery Department, Emergency County Hospital Craiova, Romania
4 Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova

BAKGROUND

Hepatocellular carcinoma (HCC) is one of the most frequent type of primary liver cancer with high mortality witch presents lungs, bone and lymph node metastasis. In a few cases HCC determined spleen
metastases, almost 0,8%.

METODOLOGY

• We report case of a male patient, 72 years old, with no CEUS

significant pathological history, who presented in our department,
accusing loss of appetite, abdominal pain and physical asthenia, The liver lesions present inomogenous and chaotic enhancement in
for a few weeks. The physical examination showed hepatomegaly arterial phase with wash-out slowly and uncompleted in portal phase
with firm consistency and splenomegaly.
• The biological panel in this case showed a compensation liver
cirrhosis, AFP (Alpha-fetoprotein)>1000IU/ml(N<5,8IU/ml) and
serological markers for hepatitis were positive for HVC
RESULTS antibodies.
Abdominal US showed an unregular liver contour and inomogenous
structure, with evidence of a hyperecogene lesion in segment V of
hepatic right lobe, with hypoecogeneous halou measuring 6,5/5mm,
and near by portal vein another lesion of 3/2cm. Spleen measuring 15
cm with a hypoecogen, homogeneous formation of superior pole of
4/2,3cm.
Splenic lesion presents completely enhancement in arterial phase,
inomogenous and completely wash out in portal phase

DISCUSSION

• In CEUS, both liver lesions present inomogenous and chaotic enhancement in arterial phase with wash-out slowly and uncompleted in portal phase, sugesting
hepatocellular carcinoma, LIRADS V (LIRADS classification) and the splenic lesion, in clinical context, was suggestive for splenic secondary determinations.
• Computer tomography and AFP with high level, and clinical aspects in a patient with liver cirrhosis sustained our diagnosis.
• The patient received treatment with Sorafenib 800mg/zi, from july 2015 until present, with partial response, conform RECIST criteria, with regression of
viable tumor lesions.

CONCLUSIONS:

 CEUS represents a non invasive and accessible ultrasonography method with high sensibility and sensitivity for
diagnosis and monitoring of patients with HCC and secondary determinations.
 Ussualy the spleen metastasis are represented more frecvent by ovarian cancer, gastric and colon cancer in rare cases.
 It is uncommon splenic metastasis from hepatocellular carcinoma, being reported in literature, below 1% of cases.