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慢性病毒性肝炎相关肝硬化中发生的肝内胆管癌:两例移植病例。

Intrahepatic cholangiocarcinoma arising in chronic viral hepatitis-associated cirrhosis: two transplant cases.

作者信息

Nart D, Ertan Y, Pala E E, Zeytunlu M, Kilic M, Yilmaz F

机构信息

Department of Pathology, Faculty of Medicine, Ege University, Izmir, Bornova, Turkey.

出版信息

Transplant Proc. 2008 Dec;40(10):3813-5. doi: 10.1016/j.transproceed.2008.06.071.

Abstract

Hepatitis C virus (HCV) or hepatitis B virus (HBV)-related cirrhosis is known to be a risk factor for hepatocellular carcinoma (HCC). Recently, these viruses have been reported to have an etiologic role in the development of intrahepatic cholangiocarcinoma (ICC). Herein we have reported two cases of HCV- and HBV-related cirrhosis with ICC in whom the pretransplant diagnosis was HCC. The patient with HCV cirrhosis, was a 47-year-old woman with a large nodule in the right lobe. The patient with HBV cirrhosis was a 45-year-old man with two nodules. Serum tumor marker levels, carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and carbohydrate antigen 19-9 (CA 19-9) were determined before live donor liver transplantation (LDLT). The patient with HCV cirrhosis showed mildly elevated serum levels of AFP. The patient with HBV cirrhosis showed an elevated CA 19-9 level. On microscopic examination, all nodules exhibited typical morphological findings of adenocarcinoma. The patient with HCV cirrhosis developed brain metastases 4 years after LDLT. The patient with HBV cirrhosis is disease-free at 18 months after transplantation. In cirrhotic patients with active malignancy who are candidates for LDLT, ICC should be considered in the differential diagnosis. Although the literature is limited, selected patients with ICC may benefit from LDLT.

摘要

丙型肝炎病毒(HCV)或乙型肝炎病毒(HBV)相关的肝硬化是肝细胞癌(HCC)的已知危险因素。最近,据报道这些病毒在肝内胆管癌(ICC)的发生中具有病因学作用。在此,我们报告了两例HCV和HBV相关肝硬化合并ICC的病例,其移植前诊断为HCC。患有HCV肝硬化的患者是一名47岁女性,右叶有一个大结节。患有HBV肝硬化的患者是一名45岁男性,有两个结节。在活体供肝肝移植(LDLT)前测定了血清肿瘤标志物水平,癌胚抗原(CEA)、甲胎蛋白(AFP)和糖类抗原19-9(CA 19-9)。患有HCV肝硬化的患者血清AFP水平轻度升高。患有HBV肝硬化的患者CA 19-9水平升高。显微镜检查显示,所有结节均表现出腺癌的典型形态学特征。患有HCV肝硬化的患者在LDLT后4年发生脑转移。患有HBV肝硬化的患者在移植后18个月无疾病。对于LDLT候选的有活动性恶性肿瘤的肝硬化患者,鉴别诊断时应考虑ICC。尽管文献有限,但部分ICC患者可能从LDLT中获益。

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