Background: Radiofrequency thermal ablation (RFTA) has become a popular method of unresectable liver tumor ablation. However, its side effects should be paid attention to. Case Report: A 76-year-old woman was found with an 8.4 × 6.9 cm subcapsular mass in the left lateral liver lobe. She had cirrhosis with active hepatitis C. Well-differentiated hepatocellular carcinoma (HCC) was diagnosed based on fine needle aspiration biopsy (FNAB) of the liver mass. Later she was treated with ultrasound-guided percutaneous RFTA using an expandable-type electrode. Contrast-enhanced computer tomography (CT) suggested that the necrosis of the tumor was complete. Every 3 months, she had a follow-up, consisting of clinical and abdominal CT examinations. One year after treatment, a 3-cm soft tissue mass was found in the upper abdominal wall. The mass was resected and it was diagnosed as metastatic HCC. Conclusion: This case indicated that percutaneous RFTA was effective in local control of large HCC. However, the diagnostic FNAB, or percutaneous RFTA itself, may result in needle-track tumor seeding.

Keywords:
Radiofrequency thermal ablation, Hepatocellular carcinoma, Needle-track tumor seeding, Percutaneous ethanol injection, Fine needle aspiration biopsy, Cool-tip electrode, Expandable-type electrode
1.
Shiina S, Teratani T, Obi S, Hamamura K, Koike Y, Omata M: Non-surgical treatment of hepatocellular carcinoma: From percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology 2002;62(suppl 1):64–68.
2.
Solbiati L, Goldberg SN, Ierace T, Livraghi T, Meloni F, Dellanoce M, Sironi S, Gazelle GS: Hepatic metastases: Percutaneous radiofrequency ablation with cooled-tip electrodes. Radiology 1997;205:367–373.
3.
Bowles BJ, Machi J, Limm WM, Severino R, Oishi AJ, Furumoto NL, Wong LL, Oishi RH: Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 2001;136:864–869.
4.
Llovet JM, Vilana R, Bru C, Bianchi L, Salmeron JM, Boix L, Ganau S, Sala M, Pages M, Ayuso C, Sole M, Rodes J, Bruix J: Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001;33:1124–1129.
5.
De Sio I, Castellano L, De Girolamo V, di Santolo SS, Marone A, Del Vecchio BC, Marone G: Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001;34:609–610.
6.
Goldberg SN, Solbiati L: Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001;34:609–601.
7.
Livraghi T: Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001;34:608–609.
8.
Bolondi L, Gaiani S, Celli N, Piscaglia F: Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001;34:608–611.
9.
Shirato K, Morimoto M, Tomita N, Kokawa A, Sugimori K, Saito T, Tanaka K: Hepatocellular carcinoma: A case of extrahepatic seeding after percutaneous radiofrequency ablation using an expandable needle electrode. Hepatogastroenterology 2002;49:897–899.
10.
Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, De Wever I, Michel L: Complications of radiofrequency coagulation of liver tumors. Br J Surg 2002;89:1206–1222.
11.
Goldberg SN, Gazelle GS, Mueller PR: Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques and diagnostic imaging guidance. AJR Am J Roentgenol 2000;174:323–331.
12.
Curley SA, Izzo F, Ellis LM, Nicolas VJ, Vallone P: Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 2000;232:381–391.
13.
McGhana JP, Dodd GD 3rd: Radiofrequency ablation of the liver: Current status. AJR Am J Roentgenol 2001;176:3–16.
14.
Kim SH, Lim HK, Lee WJ, Cho JM, Jang HJ: Needle-tract implantation in hepatocellular carcinoma: Frequency and CT findings after biopsy with a 19.5-gauge automated biopsy gun. Abdom Imaging 2000;25:246–250.
15.
Takamori R, Wong LL, Dang C, Wong L: Needle-tract implantation from hepatocellular cancer: Is needle biopsy of the liver always necessary? Liver Transpl 2000;6:67–72.
16.
Frilling A, Broelsch CE: Resection of hepatocellular carcinoma without preoperative tumor biopsy. Ann Surg 2002;235:604–605.
17.
Di Stasi M, Buscarini L, Livraghi T, Giorgio A, Salmi A, de Sio I, Brunello F, Solmi L, Caturelli E, Magnolfi F, Caremani M, Filice C: Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates. Scand J Gastroenterol 1997;32:1168–1173.
18.
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS: Hepatocellular carcinoma: Radiofrequency ablation of medium and large lesions. Radiology 2000;214:761–768.
19.
Choi D, Lim HK, Kim SH, Lee WJ, Jang HJ, Lee JY, Paik SW, Koh KC, Lee JH: Hepatocellular carcinoma treated with percutaneous radiofrequency ablation: Usefulness of power Doppler US with a microbubble contrast agent in evaluating therapeutic response-preliminary results. Radiology 2000;217:558–563.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.