Yeon Kyeong Kim, et al. Supraumbilical Skin Rash as a Rare Complication of Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Ca

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1 ; TACE A bstract Supraumbilical Skin Rash as a Rare Complication of Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma Yeon Kyeong Kim, Yo Ahn Suh, Yong Whan Song, Jong Gwang Kim, Sook-Hyang Jung, Chul Ju Han, You Cheoul Kim, Chang-Min Kim, Jhin Oh Lee, Byung Hee Lee1, Kyung Jin Rhim2, Seung-Sook Lee3 and Jin-Haeng Chung3 Department of Internal Medicine, Diagnostic Radiology1, Dermatology2, Anatomic Pathology3 Korea Cancer Center Hospital, Seoul, Korea T ranscatheter arterial chemoembolization (T ACE) is a therapeutic option for unresectable hepatocellular carcinoma. Supraumbilical skin rash is a rare complication of T ACE caused by patent hepatic falciform artery. We report herein tw o cases of supraumbilical skin rash developed after T ACE for hepatocellular carcinoma, w ith discussion on the pathogenes is, prophylaxis, and treatment. Key w ords : T ranscatheter arterial chemoembolization, Hepatic falciform artery, Neoplasm/Liver/ Hepatocellular carcinoma, Skin rash, ; ; Abbreviations: - FP, alfa- fetoprotein; ALT, alanine aminotransferase; anti- HCV, antibody to hepatitis C virus; AST, aspartate aminotransferase; BSA, body surface area; CT, computed tomography; DNA, deoxyribonucleic acid; HBeAg, hepatitis B envelope antigen; HBsAg, hepatitis B surface antigen; HFA, hepatic falciform artery; INR, international ratio; PT, prothrombin time; RIBA, recombinant immunoblot assay; T ACE, transcatheter arterial chemoembolization :, 215-4, ( ) Phone: 02) ; Fax: 02) ; E- mail: jsh@kcchsun.kcch.re.kr

Yeon Kyeong Kim, et al. Supraumbilical Skin Rash as a Rare Complication of Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma 371 3,1 80%, 10-30%.

1oC,,, 2 5x12 cm 1 47 5 B. 2.,. 4,520/, 14.5 g/dl, 122,000/, 7.1 g/dl, 3.8 g/dl, 1.0 mg/dl, AST 49 U/L, ALT 51 U/L, PT 11.1 (157% INR 0.84). HBsAg, HBeAg, - FP 227.9 ng/ ml. F1.

2 Yeon Kyeong Kim, et al. Supraumbilical Skin Rash as a Rare Complication of Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma 371 3,1 80%, 10-30%.2,3 (transcatheter arterial chemoembolization: TACE TACE ) Yamada 4. T ACE,. T ACE hepatic falciform artery( HFA ),. T ACE 2. 6,..,, adriamycin 76.5 mg (50 mg/m BSA) lipiodol 6 ml 3/4, 1/ oC,,, 2 5x12 cm B. 2.,. 4,520/, 14.5 g/dl, 122,000/, 7.1 g/dl, 3.8 g/dl, 1.0 mg/dl, AST 49 U/L, ALT 51 U/L, PT 11.1 (157% INR 0.84). HBsAg, HBeAg, - FP ng/ ml. F1. CT ( 1) 4 4 cm Figure 1. CT scan obtained after T ACE shows lipiodol- laden lesion in segment 4 of the liver and thrombi in left and main portal vein. Fig ure 2. Irregular shaped erythematous supraumbilical skin rash (5 12 cm)( ), umbilicus ( ).

372 6 3 2000 Figure 3. Mild perivascular mononuclear cell infiltration in skin biopsy (H&E, 40) Fig ure 4.

. 2,840/, 12.6 g/dl, 45,300/ 7.2 g/dl, 4.0 g/dl, 2.3 mg/dl, AST 33 U/L, ALT 27 U/L, PT 13.4 (84%, INR 1.10).

3 Figure 3. Mild perivascular mononuclear cell infiltration in skin biopsy (H&E, 40) Fig ure 4. Celiac arteriogram shows hypervascular mass in left hapatic lobe. T he hepatic falciform artery ( ) originates from left hepatic artery.. 2,840/, 12.6 g/dl, 45,300/ 7.2 g/dl, 4.0 g/dl, 2.3 mg/dl, AST 33 U/L, ALT 27 U/L, PT 13.4 (84%, INR 1.10). HBs Ag/ Ab(+/- ), anti- HCV(+), RIBA (+), - FP 63,400 ng/ ml,. CT 4 3 cm,, T ACE 2. CT ( 5) lipiodol, 3 T ACE adriamycin 30 mg, mitomycin 10 mg, lipiodol 2 ml,., ( 6) HFA. ( 2). ( 3), ( 4) HFA T ACE,,,,,,.,,,,,

12. TACE 2 373 Figure 5. CT scan obtained after T ACE show s dense lipiodol- laden lesion in segment 4 of the liver. Figure 6.

T he hepatic falciform artery ( ) is demonstrated.,.5,6,7,. William HFA, HFA.8 9, 66 4 8 1.

4 12. TACE Figure 5. CT scan obtained after T ACE show s dense lipiodol- laden lesion in segment 4 of the liver. Figure 6. Celiac arteriogram shows hypervascular mass supplied by left hepatic artery ( ). T he hepatic falciform artery ( ) is demonstrated.,.5,6,7,. William HFA, HFA.8 9, cm T ACE HFA, cisplatin, lipiodol, zinostatin stilmalamer gelfoam, HFA. T ACE 2,, cm 1. 2,. HFA, hepatic falciform ligament, internal thoracic artery, superior epigastric artery.8 HFA 2-13%.8,10 67% 11, HFA, TACE

5 374 The Korean Journal of Hepatology : Vol. 6. No HFA. hepatic falciform ligament, HFA.12 HFA.13, HFA.10 HFA T ACE, Ueno 13 T ACE HFA microcoil T ACE. Kim cisplatin (2 mg/kg) TAC 93 lipiodol cisplatin 1:1 gelfoam TACE HFA 16, HFA. HFA, lipiodol, lipiodol vesicant. Vesicant adriamycin, mitomycin, vincristine, vinblastine, vinorelbine. T ACE adriamycin 0.6-6%.14,.15, adriamycin- DNA,16.15, DNA 2.16, 17.,18 hyaluronidase.15,19 1 T ACE, HFA adriamycin 76.5 mg T ACE. 2 3 TACE, 1, 2 TACE,, HFA.. HFA, HFA. T ACE, T ACE HFA. HFA, HFA.

6 Yeon Kyeong Kim, et al. Supraumbilical Skin Rash as a Rare Complication of Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma 375 :,, ; ,,,,. AP (Doxorubi cin, Cisplatin). 1997;29: ,,. FAM. 1991;41: Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, T akashima S. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983;34: Chung JW, Park JH, Han JK, et al. Hepatic tumors: Predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996;198: ,,. Lipiodol ;33: ,,. T AE ;5: W illiam s DM, Cho KJ, Ensm inger W D, Ziessman HA, Gyves JW. Hepatic falciform artery: anatomy, angiographic appearance, and clinical significance. Radiology 1985; 156: Umemura T, Yamamura N, Nagata A, et al. Case report: Steatonecrosis in the upper abdomen following transcatheter arterial embolization for hepatocellular carcinoma. J Gastroenterol Hepatol 1998;13: Kim DE, Yoon HK, Ko GY, Kw on JS, Song HY, Sung KB. Hepatic falciform artery: Is prophylactic embolization needed before short- term hepatic arterial chemoinfusion? Am J Radiol 1999;172: Michels NA. Collateral arterial pathways to the liver after ligation of hepatic artery and removal of the coeliac axis. Cancer 1953;6: Charnsangavej C, Chuang VP, Wallace S, Soo CS, Bowers T. Angiographic classification of hepatic arterial collaterals. Radiology 1982;144: Ueno K, Miyazono N, Inoue H, Miyake S, Nishida H, Nakajo M. Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiology 1995;18: Larson DL. T reatment of tissue extravasation by antitumor agents. Cancer 1982; 49: Bekerecioglu M, Kutluhan A, Demirtas I, Karaayvaz M. Prevention of Adriamycininduced skin necrosis with various free radical scavangers. J Surg Res 1998;75: Eminoglu M, Eercocen A, Demiseren A, Yenidunya S, Edah N. Histopathological changes in Adriamycin extravasation injury. Ann Plast Surg 1998;41: Larson DL. What is the appropriate management of tissue extravasation by antitumor agent? Plast Reconstr Surg 1985; 75: Dorr RT, Alberts DS, Chen HSG. T he limited role of corticosteroids in ameliorating experimental doxorubicin skin tox-

7 icity in the m ouse. Cancer Chem other Pharmacol 1980;5: Disa JJ, Chang RR, Mucci SJ, Goldberg NH. Prevention of Adriamycin- induced full- thickness skin loss using hyaluronid ase infiltration. Plast Reconstr Surg 1998; 101:

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<30382EC0C7C7D0B0ADC1C22E687770> 대한내과학회지: 제 76 권 제 2 호 2009 의학강좌-개원의를 위한 모범처방(Current Clinical Practice) 간기능검사의 이해와 적용 인제대학교 의과대학 일산백병원 내과학교실 김 경 아 Understanding and application of liver function tests Kyung-Ah Kim, M.D. Department of