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丙型肝硬化患者肝脏同一亚段内同时发生肝细胞癌和肝内胆管癌。

Synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type C liver cirrhosis.

作者信息

Watanabe Takuya, Sakata Jun, Ishikawa Takashi, Shirai Yoshio, Suda Takeyasu, Hirono Haruka, Hasegawa Katsuhiko, Soga Kenji, Shibasaki Koichi, Saito Yukifumi, Umezu Hajime

机构信息

Takuya Watanabe, Haruka Hirono, Katsuhiko Hasegawa, Kenji Soga, Koichi Shibasaki, Department of Internal Medicine and Gastroenterology, Medical Hospital, The Nippon Dental University School of Life Dentistry at Niigata, 1-8, Hamauracho, Chuo-ku, Niigata 951-8580, Japan.

出版信息

World J Hepatol. 2009 Oct 31;1(1):103-9. doi: 10.4254/wjh.v1.i1.103.

Abstract

As a result of having undergone computed tomography (CT), a 75-year-old woman with type-C liver cirrhosiswas shown to have two tumors on the ventral and dorsal sides of subsegment 3 (S3). The tumor on the ventral side was diagnosed as a classic hepatocellular carcinoma (HCC), while that on the dorsal side was considered atypical for a HCC. Although the indocyanine green (ICG) findings indicated poor hepatic reserve, the prothrombin time (PT) was relatively good. An operation was performed in February 2007; however, this resulted in exploratory laparotomy. Dynamic CT performed 12 mo after the operation revealed that the tumor on the dorsal side of S3 had apparently increased. The marginal portion of the tumor was shown to be in the early and parenchymal phases, while the internal portion was found to have grown only slightly in the delayed phase. We diagnosed this tumor as a cholangiocellular carcinoma (CCC). S3 subsegmentectomy was performed in April 2008. The tumor on the ventral side was pathologically diagnosed as a moderately differentiated HCC, and that on the dorsal side was diagnosed as a CCC. We can therefore report a rare case of synchronous development of HCC and CCC in the same subsegment of the liver in a patient with type-C liver cirrhosis. We also add a literature review for all the reported cases published in Japan and around the world, and summarize the features of double cancer exhibiting both HCC and CCC.

摘要

一名75岁的丙型肝硬化女性接受计算机断层扫描(CT)检查后,显示在肝3段(S3)腹侧和背侧有两个肿瘤。腹侧肿瘤被诊断为典型肝细胞癌(HCC),而背侧肿瘤被认为不符合HCC的典型特征。尽管吲哚菁绿(ICG)检查结果显示肝脏储备功能较差,但凝血酶原时间(PT)相对较好。2007年2月进行了手术,但结果是剖腹探查。术后12个月进行的动态CT显示,S3背侧的肿瘤明显增大。肿瘤边缘部分在动脉期和实质期显影,而内部部分在延迟期仅略有增大。我们将此肿瘤诊断为胆管细胞癌(CCC)。2008年4月进行了S3亚段切除术。腹侧肿瘤经病理诊断为中分化HCC,背侧肿瘤诊断为CCC。因此,我们报告了一例丙型肝硬化患者肝脏同一亚段同时发生HCC和CCC的罕见病例。我们还对日本和世界各地报道的所有病例进行了文献综述,并总结了同时出现HCC和CCC的双癌特征。

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