TMSS Medical College Journal

Background: The highest incidence of Hepatocellular carcinoma (HCC) is in Asia, accounting for about 76% of all cases worldwide. In South East Asia, hepatitis B is the most common underlying cause. HCC exhibits intense neoangiogenic activity during its progression. In the early stages the tumor is not highly vascularized and its blood supply comes from the portal vein. However, as the tumor grows the blood supply becomes progressively arterialized. HCC have to invasion the portal venous system, which results in portal vein tumor thrombus (PVTT). Objectives: To find out the relationship of portal vein tumor thrombus (PVTT) with the hepatitis B-related hepatocellular carcinoma. Methods: This observational study was carried out in the Department of Hepatology, BSMMU from January 2012 to December 2013. The study was approved by the Ethical Institutional Review Board (IRB) of BSMMU, Dhaka. The diagnosis of HCC was confirmed by pathological examination or AFP elevation (400ng/mi) combined imaging (CT/MRI) and diagnosis of PVTT was made by non-enhanced and contrast-enhanced (10 mm slice thickness) multi-detector CT (MDCT). All CT images were evaluated by 2 trained radiologists by consensus after exclusion of hepatitis C virus infection (Anti HCV-+ve) and significant alcohol intake (20 gm. /day). All patients were HBsAg positive done by ELISA test. Results: A total 44 patients were included in this study. Among them, 91% were male (n-40) and 09 % were female (n-4). The mean age was 48.2 (+12.9) years with range from 23 to 80. Maximum (50%) patient's ages were belonged to 35-54 years. Urban was found 23 (52.3%). Cirrhosis was 79.5% (n=35) and no cirrhosis was found 20.5% (n=9). PVTT was found 41% (n=18) and no PVTT was found 59% (1-26). Among cirrhosis and non-cirthosis group, PVTT was 83% (n=15) and 17% (n-03) respectively. Conclusions From our observation we can conclude that PVTT is a significant association with HCC and PVTT increase is more in cirrhotic group. Median survival time of patients with PV invasion was 2.7 to 4 months if left untreated, whereas the median survival time of patients without PV invasion was 24.4 months if left untreated. Detection of PVTT in HCC leads 10 extremely poor prognosis.

HCC is the sixth most common malignant tumor and the third most common cause of cancer deaths worldwide'. The etiological agent of HCC is known in more than 90% of cases. In South East Asia, hepatitis B is the most common underlying cause. The highest incidence of HCC is in Asia, accounting for about 76% of all cases worldwide’. HCC exhibits intense neo-angiogenic activity during its progression. In the carly stages the tumor is not highly vascularised and its blood supply comes from the portal vein. However, as the tumor grows the blood supply becomes. progressively arterialized”. HCC has a tendency to invade the portal venous system, which results in portal vein tumor thrombus (PTT). Patients with both cirrhosis and hepatic carcinoma have the highest tisk to develop portal vein tumor thrombosis’. tisk to develop portal vein tumor thrombosis’. Based on this hypothesis, we find out the association of PVTT with the hepatitis B-related hepatocellular carcinoma