Kondo Hiroki, Tomimaru Yoshito, Iwazawa Takashi, Fujimoto Naoto, Noguchi Kozo, Nagase Hirotsugu, Ogino Takayuki, Hirota Masashi, Oshima Kazuteru, Tanida Tsukasa, Noura Shingo, Imamura Hiroshi, Akagi Kenzo, Adachi Shiro, Dono Keizo
Dept. of Surgery, Toyonaka Municipal Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2527-2529.
A 65-year-old man visited our hospital for hepatocellular carcinoma(HCC)and underwent extended posterior sectionectomy. Eight months after the hepatic resection, follow-up computed tomography(CT)revealed a solitary, recurrent tumor in S4 of the liver, and transcatheter arterial chemoembolization and radiofrequency ablation were performed for the intrahepatic recurrence. After 12 postoperative months, follow-up CT demonstrated pulmonary metastases in S5 of the right lung and S10 of the left lung. Since there were no other metastases, the 2 metastatic lesions were resected using video-assisted thoracoscopic surgery(VATS). The resected tumors were histologically diagnosed as pulmonary metastases of HCC. Three years after the pulmonary resection, 3 additional pulmonary metastases were detected on CT in S3 and S10 of the right lung and S4 of the left lung. No other metastases were found. Bilateral VATSmetastasectomy was performed for the metastases. The tumors were diagnosed as pulmonary metastases of HCC on histological examination. One year and 8 months after the surgery, he was alive in a good condition, with no recurrences. The present case suggested that some patients with pulmonary metastasis of HCC can have long-term survival with surgical resection of the metastasis. Therefore, while systemic chemotherapy is generally considered the standard treatment for extrahepatic metastasis of HCC, surgical resection might be an option.
一名65岁男性因肝细胞癌（HCC）前来我院就诊，并接受了扩大右后叶切除术。肝切除术后8个月，随访计算机断层扫描（CT）显示肝脏S4段有一个孤立的复发性肿瘤，遂对肝内复发灶进行了经导管动脉化疗栓塞术和射频消融术。术后12个月，随访CT显示右肺S5段和左肺S10段出现肺转移。由于没有其他转移灶，采用电视辅助胸腔镜手术（VATS）切除了这2个转移病灶。切除的肿瘤经组织学诊断为HCC肺转移。肺切除术后3年，CT检查发现右肺S3段和S10段以及左肺S4段又出现了3个肺转移灶。未发现其他转移灶。对这些转移灶进行了双侧VATS转移灶切除术。组织学检查诊断肿瘤为HCC肺转移。手术后1年8个月，他状况良好，无复发存活。本病例提示，部分HCC肺转移患者通过手术切除转移灶可实现长期生存。因此，虽然全身化疗通常被认为是HCC肝外转移的标准治疗方法，但手术切除也可能是一种选择。
