Oshiro Yukio, Takada Yasutsugu, Enomoto Tsuyoshi, Fukao Katashi, Ishikawa Shigemi, Iijima Tatsuo
Department of Gastrointestinal Surgery, University Hospital, Tsukuba University, Ibaraki, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1144-7.
A resected case of huge liver metastasis of hepatoid adenocarcinoma of the lung is described. A 77-year-old man who presented a solitary huge liver tumor was admitted to our hospital. He had undergone right lower lobectomy of the lung for lung cancer one year before. The view of imaging studies was not a typical one of hepatocellular carcinoma. Serum levels of AFP and PIVKA-II were 334,500ng/mL and 3,890mAU/mL, respectively, and the proportion of AFP L3 was 97.9%. It was thought that they were strongly diagnostic for hepatocellular carcinoma. Extended right lobectomy of the liver was performed. Microscopically, it was poorly differentiated adenocarcinoma and diagnosed as liver metastasis from the formerly resected lung cancer. The tumor was composed of cells with both sheet-like growth and tubule formation. The neoplastic cells, in the sheet-like growth resembled hepatocellular carcinoma cells. By immunohistochemical staining with anti-AFP and anti-PIVKA-II antibodies, cancer cells of both the primary and metastatic lesions were positive. The patient eventually died of multiple liver and bone metastasis 6 months after the operation.
本文描述了一例肺肝样腺癌巨大肝转移灶切除病例。一名77岁男性因出现孤立性巨大肝脏肿瘤入住我院。他一年前因肺癌接受了右肺下叶切除术。影像学检查结果并非典型的肝细胞癌表现。血清甲胎蛋白（AFP）和异常凝血酶原（PIVKA-II）水平分别为334,500ng/mL和3,890mAU/mL，AFP-L3比例为97.9%。认为这些结果对肝细胞癌具有很强的诊断意义。遂行扩大右肝叶切除术。显微镜下可见低分化腺癌，诊断为既往切除的肺癌肝转移。肿瘤由呈片状生长和形成小管的细胞组成。呈片状生长的肿瘤细胞类似于肝细胞癌细胞。通过抗AFP和抗PIVKA-II抗体免疫组化染色，原发灶和转移灶癌细胞均呈阳性。患者最终在术后6个月死于多发肝转移和骨转移。
