Dhaliwal Amaninder, Braseth Annie, Dhindsa Banreet S, Ramai Daryl, Rochling Fedja A
Gastroenterology and Hepatology, University of South Florida Morsani College of Medicine, Tampa, USA.
Gastroenterology and Hepatology, The University of Iowa Carver College of Medicine, Iowa City, USA.
Cureus. 2021 Jan 10;13(1):e12609. doi: 10.7759/cureus.12609.
Liver transplantation (LT) is an accepted form of therapy for selected cases of malignant tumors of the liver that include primary and fibrolamellar hepatocellular carcinoma, cholangiocarcinoma limited to Klatskin distribution, neuroendocrine tumors, epithelioid hemangioendothelioma, and hepatoblastoma. This is the case of a 61-year-old previously healthy female transferred from an outside hospital for a second opinion for a liver transplant. Computed tomography of the abdomen with contrast showed cirrhosis and multiple masses with arterial enhancement in her liver. She underwent a liver biopsy that showed a low-grade vascular tumor. She underwent an exploratory laparotomy with open liver biopsy which showed no visual evidence of omental spread. The pathology was reported as a low-grade vascular lesion, which was likely a small vessel neoplasm. After denial for LT secondary to an unknown low-grade vascular tumor, she presented to our medical center. Oncology was consulted and diagnosed with her liver vascular tumors as benign with an overall favorable prognosis. She was listed for liver transplant with a model for end-stage liver disease-sodium score of 25 and developed hepatorenal syndrome type 1. She was on hemodialysis for approximately 10 weeks prior to her LT and was eventually listed for simultaneous liver and kidney transplants. She underwent an orthotopic liver transplant 10 weeks after presenting to UNMC. The amount of necrosis and the elevated mitotic rate was sufficient to classify the tumor as a Federation Nationale des Centres de Lutte le Cancer grade 3 of three angiosarcomas. She was scheduled for a living donor kidney transplant three days after her liver transplant, but it was postponed after she continued to have increased urine output that responded to a trial of diuretics with continued improvement in kidney function. She successfully completed 16 months post-LT without any known recurrence of primary angiosarcoma.
肝移植（LT）是治疗某些肝脏恶性肿瘤的一种公认疗法，这些肿瘤包括原发性和纤维板层型肝细胞癌、局限于肝门部的胆管癌、神经内分泌肿瘤、上皮样血管内皮瘤和肝母细胞瘤。本文讲述的是一位61岁、既往健康的女性患者，她从外院转诊来寻求肝移植的二次诊断意见。腹部增强计算机断层扫描显示她患有肝硬化且肝脏有多个动脉期强化的肿块。她接受了肝活检，结果显示为低度血管肿瘤。她又接受了剖腹探查及开放性肝活检，未发现网膜转移的可视证据。病理报告为低度血管病变，可能是一种小血管肿瘤。因不明低度血管肿瘤而被拒绝肝移植后，她来到了我们的医疗中心。咨询肿瘤科后，诊断她的肝脏血管肿瘤为良性，总体预后良好。她以终末期肝病钠评分25被列入肝移植名单，并发展为1型肝肾综合征。在进行肝移植前，她接受了大约10周的血液透析，最终被列入肝肾联合移植名单。在入住内布拉斯加大学医学中心10周后，她接受了原位肝移植。坏死量和有丝分裂率升高足以将该肿瘤分类为法国国立癌症中心联盟三级血管肉瘤。肝移植三天后，她原计划接受活体供肾移植，但在尿量持续增加且对利尿剂试验有反应、肾功能持续改善后，移植被推迟。她成功完成了肝移植后16个月的随访，原发性血管肉瘤无任何已知复发情况。
