Takahashi Hidenori, Konishi Masaru, Nakagohri Toshio, Inoue Kazuto, Takahashi Shinichiro, Tanizawa Yutaka, Monden Morito, Kinoshita Taira
Department of Surgery and Clinical Oncology, Osaka University, Graduate School of Medicine, Osaka 565-0871, Japan.
Jpn J Clin Oncol. 2004 Sep;34(9):551-5. doi: 10.1093/jjco/hyh096.
We encountered a patient with hepatocellular carcinoma (HCC) with peritoneal dissemination and needle tract implantation, both of which were strongly suspected to have been caused by percutaneous needle biopsy. The patient was a 65-year-old man. Partial hepatectomy of subsegment VI had been performed following the diagnosis of HCC by percutaneous needle biopsy in February 1997. After this first surgery, the patient additionally underwent five further surgeries for the treatment of intrahepatic recurrences, peritoneal recurrences and needle tract implantation caused by the percutaneous needle biopsy. The intrahepatic and peritoneal recurrences were surgically controlled for 3 years after the fifth operation. The needle tract implantation was first resected in February 2001. Since then, treatment by surgery and radiotherapy has been administered twice for local recurrences forming tumor thrombosis of the abdominal wall. Now, 7 years after the first surgery, the patient remains alive without any evidence of recurrence. This case report serves to emphasize that needle tract implantation and peritoneal seeding caused by percutaneous needle biopsy are rare but possible complications. When such iatrogenic spreading of malignant cells occurs, aggressive multimodal treatment is well worth considering. Wide resection of the tumor including the adjacent soft tissues should be performed in these cases, considering that the tumor spreads along the subcutaneous veins in needle tract implantation of HCC and repeated aggressive surgeries could provide good local control.
我们遇到了一名患有肝细胞癌（HCC）并伴有腹膜播散和针道种植转移的患者，二者均高度怀疑是经皮穿刺活检所致。患者为一名65岁男性。1997年2月经皮穿刺活检诊断为HCC后，行Ⅵ段肝部分切除术。首次手术后，患者又接受了5次手术，以治疗经皮穿刺活检引起的肝内复发、腹膜复发和针道种植转移。第五次手术后，肝内和腹膜复发通过手术得到控制达3年。针道种植转移首次于2001年2月切除。从那时起，针对形成腹壁肿瘤血栓的局部复发，已进行了两次手术及放疗治疗。现在，首次手术后7年，患者仍存活，无任何复发迹象。本病例报告旨在强调，经皮穿刺活检引起的针道种植转移和腹膜播散虽罕见，但有可能发生。当发生这种医源性癌细胞播散时，积极的多模式治疗很值得考虑。在这些病例中，应考虑到HCC针道种植转移时肿瘤沿皮下静脉扩散，对肿瘤包括相邻软组织进行广泛切除，重复进行积极手术可实现良好的局部控制。
