The 34th Congress of The Korean Association of Hepato-Biliary-Pancreatic Surgery cation after organ transplantation which requires im- patterns of complication in the patients with mechan- munosuppressive therapy. Posttransplant immunosu- ical ileus after the feeding jejunostomy after liver ppressive medications result in decreased immune sur- transplantation can be introduced. veillance against malignant cells and increase the risk Patients and Methods: We reviewed the cases of of malignancies mediated by various viruses. In this three patients; first a 62-year-old woman who pre- study, we tried to investigate the incidence patterns sented with toxic hepatitis and received living liver and treatments of de novo malignancy after liver transplantation, second a 68-year-old woman who pre- transplantation (LT), especially mainly after living do- sented with acute on chronic HBV hepatitis and re- nor liver transplantation. ceived living liver transplantation emergently and, Methods: Between August 1992 to December 2008, third a 16-year-old woman who presented with toxic 2174 LT were performed, living donor liver trans- hepatitis on the drug and received emergent cadaveric plantation cases were 1879 and deceased donor liver liver transplantation. Their medical records were retro- transplantation cases were 295. spectively reviewed. Results: Among them, 35 patients (1.6%) revealed de Results: One patient showed self limited recovery novo malignancies. In this single-center series, the in- with hydration and restricting diet. The other patients cidence rate of de novo malignancy was rather low required emergent operation. The performing of feed- (1.6%). The patterns of de novo malignancy were also ing jejunostomy during the liver transplantation must different from those in western countries. The com- be considered seriously because of its urgent mon malignancies were stomach cancer and colon complication. cancer in this series, but skin cancer, lymphoma and lung cancer were more common in western countries. Conclusion: In our institution, posttransplant peri- 18 odic checkup was done in every 1-year basis, espe- cially focused on common malignancies in Korea. The periodic checkup list always includes gastrofiberscopy Unusual Type of Hepatic Hemangioma for early detection of stomach cancer. The common Mimicking Hepatocellular Carcinoma: malignancies usually occur in transplant patients at an High-Flow Pattern on MRI earlier age than in the general population. Thus year- Department of Surgery, Chonnam National University ly screening checkup may be beneficial regardless the Medical School, Korea age of liver recipients. Eunkyu Park, Yang Seok Koh, Young Hoe Hur, Ho Hyun Kim, Jin Shick Seoung, Jung Chul Kim, Hyun Jong Kim, Chol Kyoon Cho 17 Introduction: The hepatic hemangiomas could be Mechanical Ileus Associated Feeding distinguished with hepatocellular carcinoma (HCC) in Jejunostomy after Liver Transplantation the point of showing bright signal intensity on un- enhanced T2-weighted imaging of MRI. However, Department of Hepatobiliary Surgery and Liver some atypical hemangiomas, especially high-flow he- Transplantation, University of Ulsan College of Medicine and mangiomas, can display rapid, intense homogeneous Asan Medical Center, Seoul, Korea arterial enhancement and can show isointense or CS Park, SG Lee, S Hwang, KH Kim, CS Ahn, slightly hyperintense signal during the equilibrium DB Moon, TY Ha, GW Song, DH Jung, GC phase of liver MRI using gadoxetic acid-enhancement Park, YD Yoo, PJ Park, YI Choi, SY Yoon, JM MRI. Therefore, these early enhancing types of he- Namgung, SW Jung, HW Park, HJ Lee mangiomas can mimic hypervascular hepatic tumors, such as HCC. We report the case of high-flow hepatic Background: There are many complication associated hemangioma confused with HCC. with feeding jejunostomy with liver transplantation. Case: A 65-year-old male presented our hospital with Mechanical ileus is also often seen after the feeding liver mass detected by heath survey and he had no jejunostomy after liver transplantation. Three different history of hepatitis and liver cirrhosis. Enhanced com-

212 Poster puted tomography showed early enhancing and early washed out well marginated exophyting solid mass in 19 left lateral segment of liver. Serum alpha-fetoprotein was within normal range and hepatitis viral marker Hepatic Resection for Initially Inoperable indicated negative for viral hepatitis. This hepatic le- Hepatocellular Carcinoma (HCC); Pretreated sion was showed as slightly low signal intensity on T1 weighed imaging and heterogeneous signal in- Hepatic Aterial Infusion of Chemotherapy tensity on T2 weiged imaging of MRI. Moreover it (HAIC) was well enhanced at arterial phase and washed out Division of Hepatobiliary Surgery and Liver Transplantation, at delayed phase. So he was diagnosed HCC and un- Department of Surgery, Asan Medical Center, University of derwent wedge resection of left lateral segment of Ulsan College of Medicine, Korea liver. At surgery, there was 3 cm sized well margi- Gilchun Park, Donghwan Jung, Giwon Song, nated soft mass in the liver. Postoperative Histology Taeyong Ha, Dukbok Moon, Kihun Kim, and immunohistochemistry revealed that the hepatic Chulsoo Ahn, Shin Hwang, Sunggyu Lee mass was not HCC but hemangioma. The post- operative course was uneventful and he discharged 1 Introduction: Treatment of advanced HCC remains week after surgery. a significant problem for clinicians. Numerous clinical Discussion: Problematic issues might occur in the studies have shown that HAIC provides moderate differentiation of high-flow hemangiomas from HCC therapeutic efficacy with substantially favorable tox- after gadoxetic acid–enhanced MRI if the lesion shows icity profiles in selected patients groups with ad- a pseudo washout sign. A high-flow hemangioma on vanced HCC. We present our experience of two pa- gadoxetic acid–enhanced MRI could show bright signal tients with initially inoperable advanced HCC who on a T2-weighted image; a rapid, intense homoge- underwent hepatic resection after pretreated HAIC. neous or dominant portion enhancement on the arte- Case Report: First case was 45 year old man who rial phase; or a pseudo washout pattern on the equili- had multiple HCC with portal vein tumor thrombus brium phase. The pseudo washout sign was not con- (PVTT) in both lobs of liver at Dec. 2009. From Jan. sidered a true contrast wash out as occurs in HCC. 2010 to Jun. 2010, HAIC with 5-FU, mitomycin, epi- Rather, it was thought to be due to contrast uptake rubicin was performed six cycles and transarterial che- in the surrounding normal liver parenchyma; the le- moembolization (TACE) once. At Jan. 2011, he under- sion itself might have low signal intensity. High-flow went partial hepatectomy uneventfully and discharged hemangiomas should be considered when the follow- well. Second case was 51 year old woman who had ing are observed: bright signal intensity on T2-weigh- huge HCC with PVTT in left lobe at Oct. 2008. She ted imaging, arterial-phase dominant enhancement, took HAIC treatment with 5-FU, cisplatin six cycles pseudo washout sign during the equilibrium phase, till Apr. 2009 in spite of favorable toxicity frequent perilesional arterioportal shunt, and iso- (leukopenia). Left trisectionectomy and caudate lobec- intensity or slightly increased signal intensity on the tomy with PVTT thrombectomy was performed subtraction images between the unenhanced phase and successfully. Until now, there is no evidence of dis- the equilibrium phase. ease recurrence. Conclusions: For initially unresectable HCC without liver cirrhosis, HAIC may be an effective treatment modality. We suggest that more clinical studies should be undertaken to explore the use of HAIC for ad- vanced HCC patients.

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