Kutty Divya Narayanan, Kanchana M P
Post Graduate Student, Department of Pathology, Madras Medical College , Chennai, Tamil Nadu, India .
Professor, Department of Pathology, Institue of Obstetrics and Gynaecology, Madras Medical College , Chennai, Tamil Nadu, India .
J Clin Diagn Res. 2016 Apr;10(4):ED13-5. doi: 10.7860/JCDR/2016/17715.7603. Epub 2016 Apr 1.
Haemoperitoneum in pregnancy is a rare, but potentially fatal condition. Primary hepatocellular carcinoma (HCC) in pregnancy is also very uncommon. Primary hepatocellular carcinoma occuring in a pregnant lady and presenting with massive haemoperitoneum is, to the best of our knowledge, the first case to be reported in world literature. Here we present a case of 32-year-old female who had no typical risk factors for HCC; was in nineteenth week of gestation presented with abdominal pain. Following a spontaneous expulsion of a dead and macerated foetus, she developed massive haemoperitoneum due to rupture of a liver mass. This caused a great diagnostic challenge for us to differentiate between the benign Hepatocellular Adenoma (HA) and well differentiated HCC because of the age and typical clinical presentation favouring HA and the histopathological features favouring more for HCC. Diagnosis of HCC was confirmed based on the immunohistochemical findings. The differential diagnosis between HA and well differentiated HCC is very difficult and sometimes impossible especially when it occurs in young females and in pregnancy.
妊娠合并腹腔积血是一种罕见但可能致命的疾病。妊娠合并原发性肝细胞癌（HCC）也非常少见。据我们所知，一名孕妇发生原发性肝细胞癌并出现大量腹腔积血的情况在世界文献中尚属首例报道。在此，我们报告一例32岁女性病例，该患者无典型的肝细胞癌危险因素；妊娠19周时出现腹痛。在自然排出一个死亡且浸软的胎儿后，她因肝脏肿物破裂而出现大量腹腔积血。由于患者年龄及典型临床表现倾向于肝细胞腺瘤（HA），而组织病理学特征更倾向于高分化肝细胞癌，这给我们鉴别良性肝细胞腺瘤和高分化肝细胞癌带来了巨大的诊断挑战。基于免疫组化结果确诊为肝细胞癌。肝细胞腺瘤和高分化肝细胞癌的鉴别诊断非常困难，有时甚至不可能，尤其是在年轻女性和妊娠期发生时。
