Of 105 patients of hepatocellular carcinoma (HCC) treated during 1970-1988, twelve patients had spontaneous rupture of carcinomatous nodules. 1) Of previous 6 cases, five were treated by conventional surgical procedures such as packing and suture, and all died. One case underwent right lobectomy following guaze pack and lived for 15 months. 2) The recent 6 cases underwent emergency transcatheter arterial embolization (TAE ) and two died of hepatic failure due to severe cirrhosis. The other 4 cases had successful control , of bleeding which allowed further treatment of HCC ; hepatectomy in 3 and repeated TAE in one. 3) All cases had precirrhosis or cirrhosis. Pathologically, ruptured tumors expansively growing with capsule invasion of cancer cells, and portal tumor thrombus were recognized in resected or autopsy specimens. DNA aneuploid HCC on flow cytometric DNA analysis were found in 4 out of 5 cases. In conclusion, hepatic resection following embolization, when possible, would seem to be rational treatment for spontaneous rupture of HCC, although the prognosis is still extremely poor despite successful control of bleeding.
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