RARE SUPPLY OF EXOPHYTIC HEPATOCELLULAR CARCINOMA FROM SPLENIC ARTERY COLLATERALS

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver and the sixth most common malignancy worldwide. Trans arterial chemoembolization (TACE) is one of the available treatment options. The splenic artery supply of hepatocellular carcinoma (HCC) is a rare occurrence. However, in patient who had repeated chemo embolization procedures, the collateral supply from this uncommon artery can be seen. This is a case of 70 years old gentlemen who underwent 9^th TACE of a large exophytic HCC in segment IV of the liver. Multiple TACE were done previously to branches from gastroduodenal artery.  The intraprocedural coeliac axis CT Angiography showed enlarging tumour. An extrahepatic feeder artery is seen arising from collateral of splenic artery branch which mainly supply the posterior inferior portion of the tumour. The branch was successfully cannulated, and chemo  embolization was done. Rare collateral supply of HCC can be seen in patient who underwent multiple chemo embolization. Thus, evaluation of tumoral supply preembolization could give a better information of the feeder arteries.