A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma
A 5-year survivor after resection of peritoneal metastases from pedunculated-type hepatocellular carcinoma
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DOI：
10.1007/s005350200089
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发表时间：
2002-07-01
影响因子：
6.3
通讯作者：
Nakamura, S
中科院分区：
文献类型：
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作者：
Kurachi, K;Suzuki, S;Nakamura, S
我们在此报告一位切除有蒂肝细胞癌腹膜转移后存活五年的病例。一位42岁的男性于1994年10月10日接受了肝外侧段切除术，诊断为带蒂肝癌。病变与瘤内出血相关，并被大网膜覆盖，但没有腹膜转移。患者4个月后因右上腹疼痛再次入院。他的血清甲胎蛋白水平为3 ng/dl。B型肝炎病毒表面抗原（HBsAg）和丙型肝炎病毒抗体（HCV-Ab）均为阴性。腹部计算机断层扫描（CT）显示右上腹腔有两个结节性病变。他被诊断为HCC腹膜转移。因为没有其他远处转移，所以进行剖腹手术切除这些肿瘤。我们发现另外两个肿瘤，位于阑尾和回肠的肠系膜。所有四个肿瘤切除部分横结肠和阑尾切除术。肿瘤的组织病理学显示低分化HCC（Edmondson-Steiner III级）。病人在第二次手术后5年多来情况良好，无复发。有蒂肝癌患者的预后差。此外，切除肝癌腹膜转移是罕见的，因为存在腹腔内的多个种植和远处器官转移。据我们所知，我们的病人是有蒂肝癌腹膜转移切除术后存活时间最长的。
We report herein a 5-year survivor after the resection of peritoneal metastases from pedunculated hepatocellular carcinoma (HCC). A 42-year-old man underwent lateral segmentectomy of the liver, with a diagnosis of pedunculated HCC, on October 10, 1994. The lesion was associated with intratumoral hemorrhage and was covered by the greater omentum, but there were no peritoneal metastases. The patient was readmitted to our hospital 4 months later with right upper quadrant pain. His serum alpha-fetoprotein level was 3 ng/dl. Hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCV-Ab) were both negative. Abdominal computed tomography (CT) revealed two nodular lesions in the right upper abdominal cavity. He was diagnosed with peritoneal metastases from HCC. Because there were no other distant metastases, laparotomy was performed to resect these tumors. We found two other tumors, located in the mesentery of the appendix and ileum. All four tumors were resected by partial transverse colectomy and appendectomy. The histopathology of the tumors showed poorly differentiated HCC (Edmondson-Steiner's grade III). The patient has been doing well without recurrent disease for more than 5 years after the second operation. The prognosis of patients with pedunculated HCC is poor. Furthermore, resection for peritoneal metastases from HCC is rare because of the presence of multiple seeding in the abdominal cavity and distant organ metastases. To our knowledge, our patient is the longest survivor after resection of peritoneal metastases from pedunculated HCC.