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Radiofrequency ablation causes 'thermal fixation' of hepatocellular carcinoma: a post-liver transplant histopathologic study

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Clin Transplant. 2003 Aug;17(4):377-84.

Radiofrequency ablation causes 'thermal fixation' of hepatocellular

carcinoma: a post-liver transplant histopathologic study.

Coad JE, Kosari K, Humar A, Sielaff TD.

Department of Pathology, West Virginia University School of Medicine,

town, WV 26508, USA. jcoad@...

Radiofrequency ablation (RFA) is increasingly used to treat hepatocellular

carcinoma (HCC) in patients awaiting a liver transplant. Despite its

increasing use, detailed histologic information is scarce regarding the

nature of RFA-treated lesions. We identified four chronic hepatitis C

patients who had RFA of their HCC before their liver transplant. For these

four patients, we conducted a detailed histopathologic analysis of the

treated lesions in their explanted livers. The five lesions included

immediate (4 d) and long-term (14 months) post-RFA specimens. Of the five

lesions, four were completely ablated. The one incompletely ablated lesion

was also treated with chemoembolization. In the acute post-RFA period, a

zone of interstitial hemorrhage occurred at the outer boundary of the

lesion. Differing from classic tissue necrosis, the treated lesions all

showed 'thermal fixation', with preserved tissue architecture and

microscopic cellular detail. The cellular staining characteristics faded

with time, but the treated tissue became brittle, resisted tissue breakdown,

and generated a minimal wound healing response. At the periphery of the

lesion, the fibrous septae of the cirrhotic liver and vascular structures

appeared to demarcate or limit progression of the ablation front. A narrow

hypocellular fibrous boundary with a focal 'foreign body' giant cell-type

reaction developed around the edge of the ablation zone. Thus, RFA can

produce immediate and complete thermal fixation of select lesions with an

appropriate liver margin and can provide a satisfactory treatment option for

select HCC patients before a liver transplant.

Publication Types:

Case Reports

PMID: 12868996 [PubMed - indexed for MEDLINE]

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