A 34-year-old Russian computer programmer presented with abdominal pain and weight loss. Imaging showed a 17cm hepatic mass, and biopsy revealed hepatic adenocarcinoma. The patient underwent chemoembolization twice but resection was attempted and unable to clear the tumor from segment III of the liver. Next steps being considered include portal vein embolization, yttrium-90 radioembolization twice, cryoablation of segment III margin, and discussing further treatment options.

1. 34 y.o. Russian computer
programmer
Presents with abdominal pain and weight loss
Baseline imaging shows 17cm hepatic mass
Biopsy -- hepatic adenocarcinoma

2. Chemoembolization #1

3. non-con CT post
chembo 1

4. Chembo 2

5. MR post
chembo 2
What next?

6. PVE

7. Resection Attempted
• After 3.5 hours, unable to clear tumor off
segment III duct
• Abdomen closed
• Now what?

8. Y-90 x2

9. MR post Y-
90
Now what?

10. Cryo seg III margin

11. MR post
Cryo

12. MR post
Jarnigan

14. • presented with abdominal pain, fatigue,
and weight loss
• AFP >450,000
• multiple liver masses
• Bx -- HCC vs. germ cell
34 y.o. Asian mother
hep B

15. MR post chembo 1

16. Chembo 2

17. CT post
Chembo 2
Now
what?

18. RIMA chembo

19. LIMA chembo

20. Chemoembolization ComplicationsChemoembolization Complications
Non-target embolization IMANon-target embolization IMA

21. Chemoembolization ComplicationsChemoembolization Complications
Non-target embolization IMANon-target embolization IMA

22. • Coronal CT post-chembo

23. Axial CT
post-chembo
Now what?

24. Extended left
trisegmentectomy