Ishiyama Kohei, Onoe Takashi, Kubota Haruna, Kojima Masato, Hadano Naoto, Tazawa Hirofumi, Shimizu Wataru, Suzuki Takahisa, Sudo Takeshi, Shimizu Yosuke, Hinoi Takao, Kuraoka Kazuya, Kouno Hirotaka, Kohno Hiroshi, Tashiro Hirotaka
Dept. of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center.
Gan To Kagaku Ryoho. 2018 Dec;45(13):2003-2005.
We encountered a case of hepatic portal lymph node metastasis after repeated treatment for hepatocellular carcinoma (HCC)recurrence. A 73-year-old male patient underwent partial gastrectomy following rupture of a gastrointestinal stromal tumor 8 years ago. A 70mm tumor was simultaneously revealed in the posterior segment of the liver, and imatinib treatment was initiated based on the diagnosis of a metastatic liver tumor. Due to the absence of an increasing tendency in the tumor, extended posterior segmentectomy was performed, and the pathological diagnosis was moderately differentiated HCC. During observation, transcatheter arterial chemoembolization(TACE)plus radiofrequency ablation(RFA)therapy was performed twice, and partial resection of the liver was performed once again for HCC recurrence. Recently, PIVKA-Ⅱ showed a high value of 1,720mAU/mL, and follow-up computed tomography showed HCC recurrence in S4/8 and hepatic portal lymph node metastasis. TACE was administered for recurrent lesions in S4/8, and surgical resection of the hepatic portal lymph node was performed together. The pathological diagnosis revealed extensive liver tissue necrosis and moderately-topoorly differentiated HCC in the excised lymph nodes. Lymph node metastasis of HCC is rare, and in this case, a change in lymph flow caused by repeated treatment for HCC recurrence was considered a factor influencing the course.
我们遇到了一例肝细胞癌（HCC）复发经反复治疗后出现肝门淋巴结转移的病例。一名73岁男性患者8年前因胃肠道间质瘤破裂接受了部分胃切除术。同时在肝脏后段发现一个70mm的肿瘤，基于转移性肝肿瘤的诊断开始使用伊马替尼治疗。由于肿瘤无增大趋势，遂行扩大后段切除术，病理诊断为中分化HCC。观察期间，行经动脉化疗栓塞术（TACE）联合射频消融术（RFA）治疗2次，因HCC复发再次行肝脏部分切除术。近期，异常凝血酶原（PIVKA-Ⅱ）显示高值为1720mAU/mL，随访计算机断层扫描显示S4/8段HCC复发并伴有肝门淋巴结转移。对S4/8段的复发灶进行了TACE治疗，并同时对肝门淋巴结进行了手术切除。病理诊断显示切除的淋巴结中有广泛的肝组织坏死以及中低分化HCC。HCC的淋巴结转移罕见，在该病例中，HCC复发的反复治疗导致的淋巴血流改变被认为是影响病程的一个因素。
