Misdiagnosed or Incidentally Detected Hepatocellular Carcinoma in Explanted Livers: Lessons Learned
Misdiagnosed or Incidentally Detected Hepatocellular Carcinoma in Explanted Livers: Lessons Learned
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DOI：
10.12659/aot.893782
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发表时间：
2015-06-30
影响因子：
1.1
通讯作者：
Al-Manea, Hadeel
中科院分区：
文献类型：
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作者：
Abdelfattah, Mohamed Rabei;Abaalkhail, Faisal;Al-Manea, Hadeel
背景：肝外植体中肝细胞癌（HCC）的误诊或偶然发现是一个令人不愉快的意外，可能对移植后的医疗环境构成挑战。材料/方法：2001年5月至2013年12月底，我中心共完成成人肝移植463例，小儿肝移植137例。病理检查发现外植体有误诊或偶发恶性病变10例。结果：我们考虑了105例因存在HCC而行肝移植的患者；102例移植前影像学准确诊断，3例误诊为HCC，再误诊为混合性胆管癌（CC），误诊率2.9%。另有7例患者在移植肝脏中发现i-HCC。因此，109例患者因存在HCC而接受移植（其中6.5%为偶然诊断）。所有肝外植体中偶发HCC （i-HCC）的总发生率为1.2%。成人组无HCC复发，儿科组仅有1例HCC复发。所有HCC-CC混合型病变均见于成人患者。2例患者因肝移植术后胆管癌复发死亡。另一名患者在13个月的随访中仍然存活，没有复发。结论：肝移植术后误诊或偶发恶性肿瘤是一种罕见但有报道的发现。他们术前的怀疑很有挑战性。诊断这种情况需要彻底的外植体病理学研究。显然，这一不良发现的结果主要是由肿瘤生物学来判断的。
Background: Misdiagnosed or incidentally detected hepatocellular carcinoma (HCC) in liver explant is an undesirable surprise that might pose a medical challenge in the post-transplant setting.Material/Methods: From May 2001 to the end of December 2013, 463 and 137 liver transplants for adult and pediatric patients, respectively, were performed at our center. Ten cases were found to have misdiagnosed or incidental malignant lesions on pathological examination of the explant.Results: We considered 105 patients for LT because of presence of HCC; 102 patients were accurately diagnosed by pretransplant imaging and the other 3 patients were misdiagnosed as HCC and then found to have mixed HCCcholangiocarcinoma (CC) (2.9% misdiagnosis rate). Seven more patients were found to have i-HCC in explanted livers. Therefore, 109 patients were transplanted for presence of HCC (6.5% of them diagnosed incidentally). The overall rate of incidental HCC (i-HCC) among all liver explants was 1.2%.In the adult group no subjects had HCC recurrence, while only 1 subject had HCC recurrence in the pediatric group. All mixed HCC-CC lesions were found in adult patients. Two patients died from recurrence of cholangiocarcinoma after liver transplant. The other patient is still surviving with no recurrence at 13-month follow-up.Conclusions: Misdiagnosed or incidental malignancy is a rare but reported finding following liver transplantation. Their preoperative suspicion is quite challenging. A thorough explant pathology study is needed to diagnose this condition. It is evident that the outcome of this undesirable finding was judged mainly by tumor biology.