Sequential thermal ablation in combination with sclerotherapy using lauromacrogol as a successful translative therapy for an unresectable huge biliary cystadenocarcinoma: The first experience assisted by contrast-enhanced ultrasound

Article type: Research Article

Authors: Zhu, Jing-E.^{a; b; c} | Li, Jia-Xin^{a; b; c} | Zhang, Hui-Li^{a; b; c} | Li, Xiao-Long^{a; b; c} | Sun, Li-Ping^{a; b; c} | Yu, Song-Yuan^{a; b; c; *} | Xu, Hui-Xiong^{a; b; c; d; *}

Affiliations: [a] Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China | [b] Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China | [c] National Clinical Research Center for Interventional Medicine, Shanghai, China | [d] Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China

Correspondence: [*] Corresponding authors: Song-Yuan Yu, MD, Department of Medical Ultrasound, Center of Minimally Invasive Treatment of Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, 301 Yanchangzhong Rd, Shanghai 200072, China. E-mail: [email protected] and Hui-Xiong Xu, MD, PhD., Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China. E-mail: [email protected].

Abstract: Biliary cystadenocarcinoma (BCAC) is an extremely rare intrahepatic cystic tumor. Patients usually present with nonspecific symptoms such as abdominal pain, abdominal distention, and abdominal mass. This tumor occurs most commonly in the left hemiliver and is thought to mainly develop from a benign biliary cystadenoma (BCA). At present, the disease is mainly diagnosed by ultrasound, CT, MR, and other imaging methods, and the main treatment is radical surgical resection. We reported a 75-year-old female with an unresectable huge BCAC (i.e., 161×145×122 mm in three orthogonal directions) and poor general condition (40 in Karnofsky Performance Status, KPS) who received sequential thermal ablation (i.e., cryoablation and microwave ablation) in combination with sclerotherapy using lauromacrogol. The diagnosis of intrahepatic BCAC was confirmed pathologically. Preablation grayscale US showed the BCAC with a clear boundary, regular shape, and cystic-solid mixed echogenicity, which appeared as a huge multilocular cystic lesions with thick internal sepatations. Preablation contrast-enhanced ultrasound (CEUS) showed honeycomb-like hyper-enhancement of the thick internal sepatations and cystic wall in the arterial and portal phase, and sustained enhancement of the thick internal sepatations and cystic wall in the late phase. 6-month postablation CEUS showed non-enhancement in most parts of the lesion in the arterial phase and 6-month postablation MRI showed the volume reduction ratio (VRR) was about 70%. The abdominal pain and abdominal distension were relieved remarkably, and her quality of life was greatly improved (70 in KPS). In conclusion, sequential thermal ablation in combination with sclerotherapy provides a successful translative therapy for this unresectable huge BCAC with a poor general condition, which makes subsequent curative surgery or ablation possible.

Keywords: Biliary cystadenocarcinoma, microwave ablation, cryoablation, sclerotherapy

DOI: 10.3233/CH-221466

Journal: Clinical Hemorheology and Microcirculation, vol. 82, no. 1, pp. 95-105, 2022