黄疸的罕见病例：纤维板层型肝细胞癌中的胆管肿瘤血栓形成
An unusual case of jaundice: Biliary tumor thrombus in fibrolamellar hepatocellular carcinoma.
作者信息
Espinosa Jairo A, Merlo Alex, Arafeh Mohamed-Omar, Munene Gitonga
机构信息
Department of Surgery, Western Michigan University Homer Stryker School of Medicine/West Michigan Cancer Center, Kalamazoo, MI, United States.
Department of Surgery, Western Michigan University Homer Stryker School of Medicine/West Michigan Cancer Center, Kalamazoo, MI, United States.
出版信息
Int J Surg Case Rep. 2017;36:50-54. doi: 10.1016/j.ijscr.2017.03.039. Epub 2017 May 12.
BACKGROUND
Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare and unique variant of hepatocellular carcinoma (HCC) whose presentation remains inadequately described. We present a resectable case of FL-HCC which involved tumor thrombus of the common bile duct.
PRESENTATION
A 27 year-old male presenting with jaundice, abdominal pain, vomiting, hepatic dysfunction and hyperbilirubinemia was found to have a large liver mass and lymphadenopathy on preoperative imaging. A right hepatectomy with perihepatic lymph node dissection and cholecystectomy was performed. Intraoperative cholangiogram demonstrated common bile duct (CBD) obstruction. CBD exploration revealed biliary tumor thrombus relieved with biliary thrombectomy.
DISCUSSION
FL-HCC can initially present with invading obstructing biliary tumor thrombus of the CBD causing jaundice.
CONCLUSION
Preoperative surgical approach should consider CBD exploration on an individual basis for underlying obstructive biliary tumor thrombus.
背景
纤维板层型肝细胞癌（FL-HCC）是肝细胞癌（HCC）一种罕见且独特的变体，其临床表现仍未得到充分描述。我们报告一例可切除的FL-HCC病例，该病例累及胆总管肿瘤血栓形成。
病例介绍
一名27岁男性，出现黄疸、腹痛、呕吐、肝功能障碍和高胆红素血症，术前影像学检查发现肝脏有一个大肿块及淋巴结肿大。行右半肝切除、肝周淋巴结清扫和胆囊切除术。术中胆管造影显示胆总管（CBD）梗阻。胆总管探查发现胆管肿瘤血栓，通过胆管取栓术得以缓解。
讨论
FL-HCC最初可能表现为侵犯并阻塞胆总管的肿瘤血栓，导致黄疸。
结论
术前手术方法应根据个体情况考虑对潜在的阻塞性胆管肿瘤血栓进行胆总管探查。
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