Percutaneous Sacroplasty for Hemorrhagic Metastases from Hepatocellular Carcinoma
Akihiro Uemuraa,
Masaki Matsusakoa,
Yuji Numaguchia,
Masaki Okaa,
Nobuo Kobayashia,
Chikako Niinamib,
Tomonori Kawasakic and
Koyu Suzukic
a Department of Radiology, St. Luke’s International Hospital, Tokyo, Japan
b Department of Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan
c Department of Pathology, St. Luke’s International Hospital, Tokyo, Japan
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FIG 1. Sequential MR imaging findings.
A, Axial T1-weighted MR image before the first pecutaneous sacroplasty shows a large osteolytic mass in left sacrum (arrows).
B, Follow-up axial T1-weighted MR image 3 months after the first percutaneous sacroplasty shows a slight reduction of left sacral metastasis (large arrows) and growth of right sacral metastasis (small arrows). Hypointensity in the left sacral tumor represents bone cement and n-BCA (curved arrow).
C, Follow-up axial T1-weighted MR image 35 days after the second percutaneous sacroplasty showed reduction of left sacral tumor (large arrows) and slight reduction of right sacral metastasis (small arrows).
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FIG 2. CT after second percutaneous sacroplasty shows acceptable cement distribution in both metastases.
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FIG 3. Histologic analysis.
A, Specimen obtained from the tumor of the left sacrum adjacent to the injected cement. Hematoxylin and eosin staining demonstrates vast necrotic cells without apparent viable cancer cells (magnificationx100).
B, The specimen from the same area as A. Silver stain shows presence of reticulin fibers (arrows) and cordlike structure of ghost cells (arrowheads) showing necrotic hepatocellular carcinoma tissue (magnification x200).
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