Hiraki Masatsugu, Kitahara Kenji, Miyoshi Atsushi, Koga Hiroki, Nakamura Hiroaki, Kubo Hiroshi, Ikeda Osamu, Yoshioka Wataru, Nakashita Shunya, Nishihara Yunosuke, Akashi Michiaki, Azama Shinya, Kawaguchi Yasunori, Mori Daisuke, Aishima Shinichi, Aibe Hitoshi, Tanaka Toshiya, Sato Seiji
Department of Surgery, Saga Medical Center Koseikan, Saga, Japan.
Department of Surgery, Saga Medical Center Koseikan, Saga, Japan.
Int J Surg Case Rep. 2018;51:45-49. doi: 10.1016/j.ijscr.2018.07.047. Epub 2018 Aug 13.
Undifferentiated carcinoma of the liver is extremely rare. The biological characteristics and standard strategy for its treatment have not been established yet.
A 45-year-old man was admitted because of fever elevation and shivering. Abdominal computed tomography revealed a hypovascular cystic mass in segments 6 and 7 of the liver measuring 11.5 × 9.0 cm with ring enhancement and partial solid component. A diagnosis of liver abscess was made, and percutaneous transhepatic abscess drainage was performed. Reddish brown-colored pus showed no bacteria or amoebas. However, cytology demonstrated malignant cells. After additional examinations of magnetic resonance imaging and the positron emission tomography, extended posterior sectionectomy with cholecystectomy was performed. The excised specimen showed a solid and irregular tumor with extensive central necrosis. A pathological examination revealed diffuse proliferation of oval- and spindle-shaped malignant cells. Immunohistochemically, the malignant cells were diffusely positive for AE1/AE3 and vimentin and focally positive for granulocyte colony-stimulating factor and cytokeratin 19; however, hepatocyte-specific antigen, glypican 3, cytokeratin 7, and CD56 were negative. Therefore, a diagnosis of undifferentiated carcinoma of the liver was made. He has remained well without any recurrence for three years since the operation.
Undifferentiated carcinoma of the liver might grow rapidly, resulting in necrosis with a cystic component. Therefore, it can be difficult to distinguish from liver abscess.
This disease has markedly different clinical and biological features from common primary malignant tumor of the liver. However, if the tumor is a solitary mass, surgical resection might lead to a good prognosis.
肝未分化癌极为罕见。其生物学特性及标准治疗策略尚未确立。
一名45岁男性因发热寒战入院。腹部计算机断层扫描显示肝脏6段和7段有一个11.5×9.0厘米的乏血管囊性肿块，呈环形强化且有部分实性成分。诊断为肝脓肿，并进行了经皮肝脓肿引流术。红褐色脓液中未发现细菌或阿米巴原虫。然而，细胞学检查发现了恶性细胞。在进行磁共振成像和正电子发射断层扫描的进一步检查后，实施了扩大的肝后段切除术及胆囊切除术。切除标本显示为一个实性且不规则的肿瘤，伴有广泛的中央坏死。病理检查显示椭圆形和梭形恶性细胞弥漫性增殖。免疫组化显示，恶性细胞AE1/AE3和波形蛋白弥漫性阳性，粒细胞集落刺激因子和细胞角蛋白19局灶性阳性；然而，肝细胞特异性抗原、磷脂酰肌醇蛋白聚糖-3、细胞角蛋白7和CD56均为阴性。因此，诊断为肝未分化癌。自手术以来，他已健康存活三年，无任何复发。
肝未分化癌可能生长迅速，导致坏死并伴有囊性成分。因此，它可能难以与肝脓肿区分开来。
这种疾病与常见的原发性肝癌在临床和生物学特征上有显著差异。然而，如果肿瘤为孤立性肿块，手术切除可能会带来良好的预后。
