Small hepatocellular carcinoma with ring calcification: a case report and literature review.
Small hepatocellular carcinoma with ring calcification: a case report and literature review.
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伴环状钙化的小肝细胞癌一例报告及文献复习。
DOI：
10.3748/wjg.v19.i1.129
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发表时间：
2013
影响因子：
4.3
通讯作者：
S. Togo
中科院分区：
文献类型：
--
作者：
T. Murakami;D. Morioka;Hideki Takakura;Y. Miura;S. Togo
未经治疗的肝细胞癌 (HCC) 中的环状钙化极为罕见，之前的英文文献中仅报道过 3 例病例。本文报道一例伴有环状钙化的肝癌。此外，还回顾了 3 例先前报道的伴有环状钙化的 HCC 病例。这 4 例中有 3 例（包括我们的病例）进行了手术。虽然之前报道的病例中环状钙化灶的大小为3.0-3.7厘米，但我们的病例仅为1厘米。从组织学结果来看，之前报道的 2 例病例的肿瘤分化程度中等，而我们的病例分化程度较差。尽管它们的大小分化较差，但这些肿瘤在动态计算机断层扫描中没有显示出早期增强。所有钙化肿瘤在组织学上均显示出厚的纤维包膜和广泛的坏死。环形钙化被认为是由于动脉血流不足和纤维包膜厚或分化差导致增殖旺盛引起的高内压之间的不平衡引起的循环障碍所致。未经治疗的 HCC 中的环状钙化可能表明肿瘤分化程度较低。即使肿瘤体积很小，任何有环状钙化的肿瘤也应该进行肝切除，因为分化差被认为是局部消融治疗（包括射频消融）后复发的危险因素之一。
Ring calcification in untreated hepatocellular carcinoma (HCC) is extremely rare, with only 3 previously reported cases in the English-language literature. A case of HCC with ring calcification was reported in this paper. Additionally, 3 previously reported cases of HCC with ring calcification were reviewed. In 3 of these 4 cases (including our case), surgery was performed. Although the size of the ring-calcified lesion ranged from 3.0-3.7 cm in previously reported cases, the size was only 1 cm in ours. The differentiation of the tumor was moderate in the 2 previously reported cases in the histological findings and poor in ours. In spite of their poor differentiation for their sizes, these tumors showed no early enhancement in dynamic computed tomography. All calcified tumors showed a thick fibrous capsule and extensive necrosis histologically. Ring calcification was considered to result from a circulatory disturbance caused by the imbalance between the less abundant arterial blood flow and high inner pressure induced by either the thick fibrous capsule or vigorous proliferation due to the poor differentiation. Ring calcification in untreated HCC may suggest a lower differentiation of the tumor. Even if its size is small, hepatic resection should be performed for any tumor with ring calcification because poor differentiation is considered to be one of the risk factors for recurrence after local ablation therapy, including radio frequency ablation.