Yamamoto Eisuke, Katou Hiroyuki, Shigehara Fumi, Katou Reona, Takahashi Hidenori, Kamiya Ayako, Matsunaga Hiroko, Sugimoto Hitoshi, Hoshino Mayumi, Goto Hiroshi, Koshiishi Haruya, Yoshimura Tetsunori
Dept. of Surgery, Tokyo Metropolitan Ohtsuka Hospital.
Gan To Kagaku Ryoho. 2018 Dec;45(13):1955-1957.
A 57-year-old man visited our hospital with right hypochondralgia. Abdominal contrast CT showed a 10 cm sized mass in S6-7of the liver and abdominal hemorrhage areas. The tumor showed extrahepatic growth. Blood a-fetoprotein(AFP)was high at 4,447.9ng/mL. Hemostasis was performed through emergency transcatheter arterial embolization. At a later date, upper gastrointestinal endoscopy showed a 20 mm sized type 2 lesion in the gastric corpus. Therefore, we performed distal gastrectomy and right hepatic lobectomy. In histopathological findings, the gastric lesion showed identified as a hepatoid adenocarcinoma, which was positive for AFP protein. The liver lesion was negative for AFP protein, but was similar to hepatoid adenocarcinoma, and no fibrosis was observed in the background liver. Therefore, we diagnosed the tumor as a liver metastasis of AFP-producing gastric cancer. On postoperative day 31, CT showed a metastatic lesion in the S1 of the liver and ascites. Chemotherapy was not successful, and the patient died on postoperative day 75. The resection rate of metastatic liver tumor in AFP-producing gastric cancer is low. This is the second case in Japan, wherein a surgery was performed for a ruptured liver metastatic lesion.
一名57岁男性因右季肋部疼痛前来我院就诊。腹部增强CT显示肝脏S6-7段有一个10厘米大小的肿块及腹部出血区域。肿瘤呈肝外生长。血液甲胎蛋白（AFP）水平较高，为4447.9纳克/毫升。通过急诊经导管动脉栓塞术进行了止血。之后，上消化道内镜检查显示胃体部有一个20毫米大小的2型病变。因此，我们实施了远端胃切除术和右肝叶切除术。在组织病理学检查结果中，胃部病变被确认为肝样腺癌，AFP蛋白呈阳性。肝脏病变AFP蛋白呈阴性，但与肝样腺癌相似，且肝脏背景未见纤维化。因此，我们将该肿瘤诊断为产AFP胃癌肝转移。术后第31天，CT显示肝脏S1段有转移灶及腹水。化疗未成功，患者于术后第75天死亡。产AFP胃癌肝转移瘤的切除率较低。这是日本第二例针对破裂性肝转移灶进行手术的病例。
