6 3 2000 ; 370-376 TACE 2 1 2 3 3 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, 2000 6 12 ; 2000 7 4 ; 2000 7 24 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, ( )139-706 Phone: 02)974-2501; Fax: 02)972-3093; 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%.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, 1/4. 38.1oC,,, 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. 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. 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.. 2 57. 18 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. 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, 66 4 8 1.5 cm T ACE HFA, cisplatin, lipiodol, zinostatin stilmalamer gelfoam, HFA. T ACE 2,, 5 8 6 cm 1. 2,. HFA, hepatic falciform ligament, internal thoracic artery, superior epigastric artery.8 HFA 2-13%.8,10 67% 11, HFA, TACE
374 The Korean Journal of Hepatology : Vol. 6. No. 3. 2000 HFA. hepatic falciform ligament, HFA.12 HFA.13, HFA.10 HFA T ACE, Ueno 13 T ACE HFA microcoil T ACE. Kim 10 127 34 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.
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