Arakawa M, Kage M, Matsumoto S, Akagi Y, Noda T, Fukuda K, Nakashima T, Okuda K
Hepatology. 1986 May-Jun;6(3):419-22. doi: 10.1002/hep.1840060316.
Histological examination of the wall of the stomach and esophagus in patients with hepatocellular carcinoma associated with cirrhosis demonstrated intravariceal tumor thrombi in 13 (23.6%) of 55 cases studied. There were distant hematogenous metastases in 31 of them, of whom 12 (38.7%) had variceal tumor thrombi. Tumor thrombi were of varying sizes, and tumor cells appeared either intact, degenerated or necrotic. In seven cases, there was a firm adhesion of thrombi onto the vascular wall suggesting possible mural infiltration, but no extravascular metastases were noted grossly. These findings suggest a possibility of metastasis of hepatocellular carcinoma to the stomach and esophagus via the portal vein. It is also suggested that the degree of varices is not increased by tumor thrombus formation per se, and that both varices and tumor thrombi are due to extensive hepatofugal collateral circulation. Considering that 12 of 13 cases of intravariceal tumor thrombi had lung metastases, a portal vein-varices-lung route is possible for lung metastasis beside the established route through the hepatic vein in hepatocellular carcinoma.
对肝硬化伴肝细胞癌患者的胃壁和食管壁进行组织学检查发现，在研究的55例病例中，有13例（23.6%）存在静脉曲张内肿瘤血栓。其中31例有远处血行转移，其中12例（38.7%）有静脉曲张内肿瘤血栓。肿瘤血栓大小不一，肿瘤细胞表现为完整、退变或坏死。7例中血栓与血管壁紧密粘连，提示可能有壁内浸润，但大体上未发现血管外转移。这些发现提示肝细胞癌可能通过门静脉转移至胃和食管。还提示肿瘤血栓形成本身并不会增加静脉曲张的程度，静脉曲张和肿瘤血栓均是由于广泛的肝外分流所致。鉴于13例静脉曲张内肿瘤血栓中有12例有肺转移，除了肝细胞癌经肝静脉转移至肺的既定途径外，门静脉-静脉曲张-肺途径也可能导致肺转移。
