Objective To summarize the updates of diagnosis and differential diagnosis for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) for providing evidences for early diagnosis and treatment of PVTT patients. Methods The related literatures on diagnosis and differential diagnosis for HCC with PVTT in recent years were collected and reviewed. Results The serious complications and tumor metastasis are attributed to the PVTT, then it is necessary to make diagnosis accurately according to clinical symptoms, hematological and imaging examinations. The differential diagnosis of PVTT and portal vein thrombosis, portal sponge degeneration and hepatic arteriovenous shunt diseases should be carried out. Conclusions The diagnosis and differential diagnosis of PVTT cannot rely on a single method, and it requires a comprehensive judgment of various diagnostic methods. More accurate and specific diagnostic methods are needed.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.