Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression
Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression
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DOI：
10.3748/wjg.v10.i22.3385
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发表时间：
2004-11-15
影响因子：
4.3
通讯作者：
Okanoue, Takeshi
中科院分区：
文献类型：
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作者：
Nakajima, Tomoki;Moriguchi, Michihisa;Okanoue, Takeshi
我们报告一位80岁的男性，他表现为肝细胞癌的自发性消退。他说右胁腹突然疼痛，发低烧。维生素K拮抗剂（PIVKA）-II诱导的蛋白水平为1 137 mAU/mL。2000年11月的计算机断层扫描显示位于肝脏S4的低密度肿块伴边缘增强，肝脏S6的囊性肿块为68 mm x 55 mm，密度稍高，无边缘增强。血管造影显示S4肿瘤大小为25 mm x 20 mm，是典型的富血供HCC，并进行了经动脉化疗栓塞。然而，在S6的肿瘤是少血供和非典型的肝癌，因此没有给予治疗。2000年12月，囊性肿块自发消退至57 mm x 44 mm，抽吸细胞学检查显示血性液体，肿块在细胞学上被诊断为I级。S4肿瘤成功治疗，周围安全边界为5 mm，PIVKA-II水平于2001年2月恢复正常。2001年7月，肿瘤进一步消退，但在后缘出现增强区。2001年11月，增强区域扩大，活检显示分化良好的HCC，尽管之前S4的肿瘤消失。血管造影显示两个肿瘤染色，一个在S6，之前是少血管的，另一个在S8。随后，PIVKA-II水平开始升高，倍增时间为2 - 3周，尽管使用凝胶泡沫反复经动脉栓塞，肿瘤仍迅速生长。2003年2月，患者死于几乎占据整个右叶的肿瘤向腹膜腔出血。考虑到症状的急性发作，我们推测局部缺血可能是由于肿瘤快速生长，导致瘤内出血和/或出血性坏死，最终S6中初始肿瘤自发消退。
We report an 80-year-old man who presented with spontaneous regression of hepatocellular carcinoma (HCC). He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist (PIVKA)-II was 1 137 mAU/mL. A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm x 55 mm in liver S6, with slightly high density content and without marginal enhancement. Angiography revealed that the tumor in S4 with a size of 25 mm x 20 mm was a typical hypervascular HCC, and transarterial chemoembolization was performed. However, the tumor in S6 was hypovascular and atypical of HCC, and thus no therapy was given. In December 2000, the cystic mass regressed spontaneously to 57 mm x 44 mm, and aspiration cytology revealed bloody fluid, and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it. The PIVKA-II level normalized in February 2001. In July 2001, the tumor regressed further but presented with an enhanced area at the posterior margin. In November 2001, the enhanced area extended, and a biopsy revealed well-differentiated HCC, although the previous tumor in S4 disappeared. Angiography demonstrated two tumor stains, one was in S6, which was previously hypovascular, and the other was in S8. Subsequently, the PIVKA-II level started to rise with the doubling time of 2-3 wk, and the tumor grew rapidly despite repeated transarterial embolization with gel foam. In February 2003, the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe. Considering the acute onset of the symptoms, we speculate that local ischemia possibly due to rapid tumor growth, resulted in intratumoral bleeding and/or hemorrhagic necrosis, and finally spontaneous regression of the initial tumor in S6.