Percutaneous ethanol injection (PEI) for hepatocellular carcinoma. History and clinical findings

A 75-year-old man was admitted because of loss of appetite, nausea with vomiting and weight loss (15 kg in 5 months). His general condition was markedly reduced. Tests: The patient had serological markers of Hepatitis B and C. Alpha-fetoprotein was elevated (70.8 U/ml) as was gamma-GT (41 U/ml), other laboratory tests were normal. Abdominal ultrasound showed a mass measuring 49 x 26 x 50 mm, corresponding to a lesion displaying inhomogenous contrast enhancement on magnetic resonance tomography, and an area of elevated glucose utilisation on positron emission tomography, respectively. Ultrasound-guided biopsy led to the histopathological diagnosis of highly differentiated hepatocellular carcinoma. Treatment and course: The patient was treated by 11 sonographically guided percutaneous ethanol injections (PEI) into the lesion. 9 months after treatment had been completed, there was no evidence of viable cancer tissue according to clinical condition, histopathology and AFP level. Conclusion: PEI may be considered for treatment of HCC in patients not eligible for an operation. This rather low-risk treatment modality may prolong survival.