CIO 2021-21 Y-90 Radioembolization of Unresectable High-Risk Hepatic Adenoma in a Patient With Chronic Liver Disease

Purpose: To describe the use of Y-90 radioembolization (Y-90 RE) for unresectable high risk hepatic adenoma in a patient with chronic liver disease.

Material and Methods: A 57 year old male with heart failure status post heart transplant complicated by congestive hepatopathy underwent a surveillance MRI demonstrating early morphologic changes of chronic liver disease and a new segment 2/3 arterially enhancing liver lesion concerning for hepatocellular carcinoma (HCC). Biopsy of the lesion, which performed because it was unclear whether the patient had underlying cirrhosis, demonstrated an inflammatory-type hepatocellular adenoma, but with staining suggestive of a beta-catenin mutation associated with malignant transformation. Given poor surgical candidacy and both suspicious imaging and histopathology, the patient was referred by multidisciplinary tumor board for Y-90 radioembolization.

Results: Pre-procedural mapping demonstrated a lung shunt fraction of 6.74% without significant extra-hepatic uptake. Subsequent Y-90 radioembolization was performed via left radial access using Therasphere particles. Dosimetry was calculated using the MIRD model with total lobar dose of 120 Gray. Post-procedural Bremsstrahlung SPECT/CT demonstrated adequate coverage over the entirety of the tumor. Post-procedural following imaging and clinic appointment was scheduled.

Conclusions: Y-90 radioembolization is a potentially feasible strategy for the treatment of high risk unresectable hepatic adenomas which have high risk pathological features and imaging findings suspicious for HCC.