Cholesterol crystal embolism in multiple organs after transarterial chemoembolization for hepatocellular carcinoma: An autopsy case report.
Cholesterol crystal embolism in multiple organs after transarterial chemoembolization for hepatocellular carcinoma: An autopsy case report.
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DOI：
10.1097/md.0000000000030769
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发表时间：
2022-09-30
期刊：
影响因子：
1.6
通讯作者：
Nakamoto, Yasunari
中科院分区：
文献类型：
--
作者：
Yamashita, Junki;Nosaka, Takuto;Takahashi, Kazuto;Naito, Tatsushi;Ofuji, Kazuya;Matsuda, Hidetaka;Ohtani, Masahiro;Hiramatsu, Katsushi;Kobayashi, Motohiro;Nakamoto, Yasunari
关键词：
肝细胞癌经导管动脉化疗栓塞术很少引起胆固醇结晶栓塞。在我们的病例中，组织学结果表明，CCE的发作发生在不同器官的不同时间点。一名72岁的日本女性HCC患者接受了TACE。TACE后，血清肌酐水平和嗜酸性粒细胞计数逐渐升高。三个月后，她因发烧和背痛住进了我科。实验室检查显示败血症伴弥散性血管内凝血。她接受了抗菌药物和抗凝剂治疗，但死于多器官衰竭。进行尸检以检查TACE 3个月后多器官衰竭的原因。在小肠中观察到慢性期栓塞伴内膜增厚和纤维化以及急性期栓塞伴炎性细胞浸润的混合物。此外，在肾脏、胃、十二指肠、结肠、胰腺和脾脏中观察到多个血管内胆固醇裂隙，这些是腹腔动脉和上级肠系膜动脉的血管优势器官。这些组织学结果表明，TACE后胆固醇晶体持续播散。肝细胞癌的TACE治疗可能导致进行性CCE和多器官损害。当TACE后观察到进行性肾功能不全、嗜酸性粒细胞增多或多器官功能障碍时，应怀疑CCE。
Transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) rarely causes cholesterol crystal embolism (CCE). In our case, the histological findings suggested that the onset of CCE occurred at different time points in different organs. A 72-year-old Japanese woman with HCC underwent TACE. After TACE, serum creatinine level and eosinophil count gradually increased. Three months later, she was admitted to our department with a fever and back pain. Laboratory examinations showed sepsis with disseminated intravascular coagulation. She was treated with antimicrobial agents and anticoagulants, but died of multiple organ failure. An autopsy was performed to examine the cause of multiple organ failure after 3 months of TACE. A mixture of both chronic phase emboli with intimal thickening and fibrosis and acute phase emboli with inflammatory cell infiltration were observed in the small intestine. Moreover, multiple intravascular cholesterol fissures were observed in the kidney, stomach, duodenum, colon, pancreas, and spleen, which were the vascular dominant organs of the celiac artery and superior mesenteric artery. These histological findings suggested that cholesterol crystals were continuously disseminated after TACE. TACE for HCC may cause progressive CCE and damage in multiple organs. When progressive renal dysfunction, eosinophilia, or multiple organ dysfunction is observed after TACE, the CCE should be suspected.
影响因子：
0.8
作者：
Hamura R;Haruki K;Iwase R;Furukawa K;Shirai Y;Onda S;Gocho T;Ikegami T
通讯作者：
Ikegami T