Kao Ching-Yun, Chang Chian-Ro, Chiang Hung, Chen How-Tshung, Shih-Ming Ma, Cheng Che-Yu
J Med Case Rep. 2009 Jun 26;3:7303. doi: 10.4076/1752-1947-3-7303.
Gall bladder carcinoma is rare, and metastatic gall bladder carcinoma from hepatocellular carcinoma has been reported in only a few patients.
We present a 73-year-old man with a history of hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma. He received transcatheter arterial chemoembolization, and was diagnosed to have an alpha-fetoprotein producing gall bladder tumor with intraluminal growth. Open cholecystectomy was performed. Pathologic examination of the lesion revealed a well-differentiated hepatoid carcinoma. The lesion was thought most likely to be a metastatic lesion from previous hepatocellular carcinoma. His alpha-fetoprotein level dropped to normal levels five months after the surgery.
This unusual intraluminal growing tumor proved to be a well-differentiated hepatoid carcinoma, most likely a metastatic lesion from previous hepatocellular carcinoma. This case reminds clinicians that in looking for likely hepatocellular carcinoma recurrence, when no detectable hepatic lesion can account for an elevated alpha-fetoprotein level, the gall bladder should be included in the search for the site of metastasis.
胆囊癌较为罕见，肝细胞癌转移至胆囊的病例仅在少数患者中被报道过。
我们报告一名73岁男性，有乙型肝炎病毒相关肝硬化和肝细胞癌病史。他接受了经导管动脉化疗栓塞术，被诊断为产生甲胎蛋白的胆囊肿瘤，呈腔内生长。实施了开放性胆囊切除术。病变的病理检查显示为高分化肝样癌。该病变最有可能是先前肝细胞癌的转移灶。术后五个月，他的甲胎蛋白水平降至正常。
这个不寻常的腔内生长肿瘤被证实为高分化肝样癌，很可能是先前肝细胞癌的转移灶。该病例提醒临床医生，在寻找可能的肝细胞癌复发时，当无可检测的肝脏病变能解释甲胎蛋白水平升高时，应将胆囊纳入转移部位的排查范围。
