Sato M, Tokui K, Watanabe Y, Lee T, Kohtani T, Nezu K, Kawachi K, Kito K, Sugita A, Ueda N
Department of Surgery II, Ehime University School of Medicine, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2561-4.
We first describe a case of generalized intraperitoneal seeding of hepatocellular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year-old man underwent operative MCT for an exophytic HCC, 60 mm in diameter, in segment IV of his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months later, radiographic examinations delineated several perihepatic masses with hypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50 mm in diameter, involved the transverse colon. Most of these intraabdominal masses were removed together with the involved colon. Histologically, the initial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progression and bleeding 2 months later. In conclusion, we should be aware of the possible occurrence of peritoneal seeding after MCT for HCC. Every effort should be made to prevent this serious complication, particularly in cases of superficial, large, and less differentiated HCCs.
我们首先描述一例肝细胞癌（HCC）经微波凝固治疗（MCT）后发生广泛性腹膜内种植转移的病例。一名61岁男性因肝硬化肝脏IV段直径60mm的外生性HCC接受了MCT手术治疗。尽管肿瘤消融成功，但MCT后血清甲胎蛋白水平持续升高。五个月后，影像学检查发现肝周有多个血管丰富的肿块，患者出现便秘。二次剖腹探查时，整个腹腔有大量小的腹膜转移灶，并有轻度血性腹水。一个直径50mm的网膜肿块累及横结肠。大部分腹腔内肿块与受累结肠一并切除。组织学检查显示，原发肿瘤为中度分化的HCC，腹膜肿块为低分化的HCC。患者在2个月后因肿瘤迅速进展和出血死亡。总之，我们应意识到HCC行MCT后可能发生腹膜种植转移。应尽一切努力预防这一严重并发症，尤其是对于浅表、较大且分化程度较低的HCC病例。
