Aoki Hideki, Arata Takashi, Utsumi Masashi, Mushiake Yutaka, Kunitomo Tomoyoshi, Yasuhara Isao, Taniguchi Fumitaka, Katsuda Koh, Tanakaya Kohji, Takeuchi Hitoshi, Yamasaki Rie
Hideki Aoki, Takashi Arata, Masashi Utsumi, Yutaka Mushiake, Tomoyoshi Kunitomo, Isao Yasuhara, Fumitaka Taniguchi, Koh Katsuda, Kohji Tanakaya, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Yamaguchi 740-8510, Japan.
World J Gastroenterol. 2017 Mar 7;23(9):1725-1734. doi: 10.3748/wjg.v23.i9.1725.
Multiple liver tumors represent a challenging condition for abdominal surgeons both in the selection of technique and the rarity of diagnosis. There are no case reports on co-existence of liver metastases from both intestinal leiomyosarcoma and adenocarcinoma. The patient described in this report successfully underwent resection of both primary lesions and liver metastases in combination with chemotherapy. As for the leiomyosarcoma, the primary cecal lesion was revealed more than three years after the patient's first visit. Peritoneal, lymph-node, and lung recurrences were observed afterward, and thus surgeries on those regions were performed. Pathologically, the peritoneal and lung recurrences comprised leiomyosarcoma and the lymph-node recurrence was diagnosed as adenocarcinoma. Despite newly discovered multiple lung recurrences and regional lymph-node metastases, the patient lived a normal life for 73 mo after the initial operation based on multidisciplinary therapy. He ultimately died of liver failure due to invasive lymph-node recurrence from the rectal adenocarcinoma, in addition to multiple lung recurrences from the leiomyosarcoma. Hepatic recurrence did not occur in this patient's case, which appears to be one reason for his long-term survival.
对于腹部外科医生而言，多发性肝肿瘤无论在技术选择还是诊断的罕见性方面，都是一项具有挑战性的病症。目前尚无关于肠道平滑肌肉瘤和腺癌肝转移共存的病例报告。本报告中描述的患者成功接受了原发灶和肝转移灶的联合切除及化疗。就平滑肌肉瘤而言，患者首次就诊三年多后才发现盲肠原发性病变。随后观察到腹膜、淋巴结和肺部复发，因此对这些部位进行了手术。病理检查显示，腹膜和肺部复发为平滑肌肉瘤，淋巴结复发诊断为腺癌。尽管新发现了多处肺部复发和区域淋巴结转移，但基于多学科治疗，患者在初次手术后仍正常生活了73个月。他最终死于肝功能衰竭，原因是直肠腺癌的侵袭性淋巴结复发以及平滑肌肉瘤的多处肺部复发。该患者未发生肝复发，这似乎是其长期存活的原因之一。
