Horiike Masaki, Sogabe Maya, Jwa Sinchul, Tokimasa Sadao, Kubo Shoji
Department of Pediatric Surgery, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubara-dori, Wakayama City, Japan.
Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Int J Surg Case Rep. 2020;76:431-434. doi: 10.1016/j.ijscr.2020.09.202. Epub 2020 Oct 10.
Although spontaneous tumor rupture is a serious complication of hepatoblastoma, there is no consensus regarding the treatment strategy in infants. We report a patient with lung metastases who had a ruptured hepatoblastoma prior to the start of the scheduled chemotherapy and was successfully treated with a combined treatment including liver resection, lung resection, and chemotherapy.
A 22-month-old boy with a ruptured hepatoblastoma and lung metastases underwent an emergency laparotomy with complete tumor resection, followed by chemotherapy. Moreover, a barely detectable metastatic lung lesion shown by a chest CT scan was resected after the fifth chemotherapy treatment. Both postoperative and chemotherapy courses were uneventful. The patient survived without any recurrent hepatoblastoma 2 years after the emergency surgery despite the poor prognosis indicated by distant metastases at the time of diagnosis.
Because rupture itself can be the main cause of death in patients with hepatoblastoma, emergency tumor hemostasis is essential. However, there are no reports comparing the prognosis of the treatment method performing tumor hemostasis alone, tumor resection after chemotherapy, and tumor hemostasis and resection at the same time. The clinical course of the patient indicates that performing tumor hemostasis and resection simultaneously and lung resection after chemotherapy is an effective option to treat a ruptured hepatoblastoma with disseminated tumors and lung metastases if the patient's condition is stable.
Aggressive treatment with surgery and chemotherapy is an effective option for ruptured hepatoblastoma with disseminated tumors and lung metastases in infants.
尽管自发性肿瘤破裂是肝母细胞瘤的一种严重并发症，但对于婴儿患者的治疗策略尚无共识。我们报告了一名伴有肺转移的患者，其在预定化疗开始前发生了肝母细胞瘤破裂，并通过包括肝切除、肺切除和化疗在内的联合治疗成功治愈。
一名22个月大患有肝母细胞瘤破裂及肺转移的男孩接受了急诊剖腹手术，完整切除肿瘤，随后进行化疗。此外，在第五次化疗后，切除了胸部CT扫描显示的一个几乎无法检测到的肺转移病灶。术后及化疗过程均顺利。尽管诊断时远处转移提示预后不良，但该患者在急诊手术后2年存活，未出现任何肝母细胞瘤复发。
由于破裂本身可能是肝母细胞瘤患者死亡的主要原因，紧急肿瘤止血至关重要。然而，尚无关于单独进行肿瘤止血、化疗后肿瘤切除以及同时进行肿瘤止血和切除这几种治疗方法预后比较的报道。该患者的临床病程表明，如果患者病情稳定，同时进行肿瘤止血和切除以及化疗后肺切除是治疗伴有播散性肿瘤和肺转移的破裂肝母细胞瘤的有效选择。
积极的手术和化疗治疗是婴儿伴有播散性肿瘤和肺转移的破裂肝母细胞瘤的有效选择。
