Portal Vein Thromboses in Malignant Hepatoma

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Abstract
A case of portal vein thromboses complicating malignant hepatoma was diagnosed by splenoportography and confirmed by postmortem examination. This prompted the review of 25 cases of primary liver cell carcinoma autopsied in the last 6 years at the Veterans Administration Hospital, Washington, D. C. to determine how frequently portal vein thrombi occur in this disease. For comparison, and in an attempt to determine how frequently portal vein thrombi occur, the autopsy of 100 cases of cirrhosis and 100 cases of carcinoma metastatic to the liver were reviewed. In our series of 25 cases of malignant hepatoma, extrahepatic portal vein thromboses was present in 8 (32%) of the cases. Of the 100 cases of cirrhosis of the liver and carcinoma metastatic to the liver, portal vein thromboses was demonstrated in 5 5%) of each. The frequency with which portal vein thromboses occurs in malignant hepatoma in this study was more than 6 times more frequent than in cirrhosis and metastatic disease of the liver. Prior to the widespread use of the needle biopsy, malignant hepatoma was rarely confirmed during life, unless an exploratory laparotomy was performed. Because of the limited material obtained by needle biopsy and the variable morphology of the tumor, even the biopsy has limited value in some hepatic tumors. It is reasonable to assume that in a patient in whom a hepatoma is suspected clinically and a liver biopsy shows either an inactive cirrhotic state or an undifferentiated malignancy, demonstration of a portal vein thrombus by splenoportography would offer substantial support to the clinical impression.

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