Aoyagi Haruhiko, Uetake Hiroyuki, Ishikawa Toshiaki, Kobayashi Hirotoshi, Higuchi Tetsuro, Yasuno Masamichi, Sugihara Kenichi
Dept. of Surgical Oncology, Graduate School, Tokyo Medical and Dental University.
Gan To Kagaku Ryoho. 2008 Nov;35(12):2141-3.
The patient was a 65-year-old male, who had been performed partial resections of the colon (descending colon cancer and rectal cancer: Stage IIIa). Multiple hepatic metastases were observed 1 year and 10 months after the operation. Hepatic arterial infusion chemotherapy was started, and a complete response for liver metastases had been continuing for 2 years. On the seventh month after the hepatic arterial infusion chemotherapy was started, a lipoma-like tumor of approximately 10 cm was found under the diaphragm on the left side. The tumor was suspected to be a lipoma on imaging and it had a tendency for enlargement. Two years and two months after hepatic arterial infusion chemotherapy was begun, the patient was hospitalized for excision of the tumor. Intraoperative findings indicated that there was a 3.5 cm mass in the greater omentum in addition to the aforementioned tumor under the left diaphragm. Both masses were excised. The histopathological findings showed that the tumor under the left diaphragm was composed of adipose tissue with coagulative necrosis. The existing adipose tissue was thought to have necroses and had become encapsulated. Similar findings were obtained for the mass in the greater omentum. Contrast study using a port system revealed stenosis of hepatic artery and defluxion of contrast medium into splenic artery and inferior phrenic artery. We speculated that the lipoma-like tumor was formed by the angitis with the change of the drug distribution.
患者为65岁男性，曾接受过结肠部分切除术（降结肠癌和直肠癌：Ⅲa期）。术后1年10个月发现多处肝转移。开始进行肝动脉灌注化疗，对肝转移灶的完全缓解持续了2年。在开始肝动脉灌注化疗后的第7个月，在左侧膈肌下方发现一个直径约10 cm的脂肪瘤样肿瘤。影像学检查怀疑该肿瘤为脂肪瘤，且有增大趋势。在开始肝动脉灌注化疗两年零两个月后，患者因肿瘤切除入院。术中发现除上述左侧膈肌下肿瘤外，大网膜还有一个3.5 cm的肿物。两个肿物均被切除。组织病理学检查结果显示，左侧膈肌下的肿瘤由伴有凝固性坏死的脂肪组织构成。现存的脂肪组织被认为发生了坏死并形成了包膜。大网膜肿物也有类似表现。使用门静脉系统的造影研究显示肝动脉狭窄，造影剂逆流至脾动脉和膈下动脉。我们推测脂肪瘤样肿瘤是由血管炎伴药物分布改变形成的。
