Haruki Koichiro, Misawa Takeyuki, Gocho Takeshi, Saito Ryota, Shiba Hiroaki, Akiba Tadashi, Yanaga Katsuhiko
Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Clin J Gastroenterol. 2016 Oct;9(5):319-23. doi: 10.1007/s12328-016-0677-0. Epub 2016 Aug 2.
Hepatocellular carcinoma (HCC) with gastric metastasis is extremely rare. There have been few reports on curative surgical resection for gastric metastasis of HCC. We herein report such a case successfully treated by simultaneous surgical resection. A 73-year-old male was admitted for evaluation and treatment of a liver tumor. Computed tomography showed an exophytic tumor of 170 mm in diameter located in the left lobe of the liver with poor delineation to the gastric wall. Upper gastrointestinal endoscopy revealed a submucosal tumor with ulceration in the antrum of the stomach. With a diagnosis of HCC with invasion to the gastric wall, an en bloc resection was planned, and the patient underwent laparotomy. The patients underwent left hemihepatectomy with partial resection of the stomach for adhesion and distal gastrectomy for the tumor. Pathological examination of the liver tumor revealed poorly differentiated HCC, and pathological diagnosis of the tumor in the submucosal and muscular layer of the stomach was compatible with metastasis from HCC, which was separate from the liver tumor. Therefore, we diagnosed the tumor as HCC with hematogenous gastric metastasis. The patient remains well with no evidence of tumor recurrence as of 13 months after resection.
肝细胞癌（HCC）伴胃转移极为罕见。关于HCC胃转移的根治性手术切除的报道很少。我们在此报告一例通过同期手术切除成功治疗的病例。一名73岁男性因肝脏肿瘤的评估和治疗入院。计算机断层扫描显示直径170毫米的外生性肿瘤位于肝左叶，与胃壁分界不清。上消化道内镜检查显示胃窦有一个伴有溃疡的黏膜下肿瘤。诊断为HCC侵犯胃壁，计划进行整块切除，患者接受了剖腹手术。患者接受了左半肝切除术，因粘连对胃进行了部分切除，并对肿瘤进行了远端胃切除术。肝脏肿瘤的病理检查显示为低分化HCC，胃黏膜下层和肌层肿瘤的病理诊断与HCC转移相符，与肝脏肿瘤不相连。因此，我们将该肿瘤诊断为HCC血行性胃转移。截至切除术后13个月，患者情况良好，无肿瘤复发迹象。
