Yamazaki Asumi, Ootosi Akihira, Chiba Masaki, Ito Kaoru, Yamagishi Toshio, Kobari Mizuo, Ueda Harumasa, Fujishima Fumiyoshi, Miyazaki Yutaka
Department of Internal Medicine, Tohokukosai Hospital.
Department of Surgery, Tohokukosai Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2022;119(2):162-171. doi: 10.11405/nisshoshi.119.162.
A 76-year-old Japanese man was admitted to our hospital with chills and fever. Computed tomography revealed a 10-cm cystic tumor with peripheral ring enhancement in the left lobe of the liver and several small low-density areas with early peripheral enhancement in both lobes. The large liver mass was diagnosed as a pyogenic abscess and treated with antibiotics. However, elevation of the tumor marker, PIVKA-II, raised the possibility of hepatocellular carcinoma. A fine-needle aspiration biopsy was performed, and malignant hepatic cells were identified. The patient underwent left hepatectomy. Histological analyses of the resected surgical specimen confirmed necrotic liver abscess and residual hepatocellular carcinoma with massive lymphoid cell infiltration. Immunohistochemical analyses revealed that the lymphoid cells were positive for CD3 and CD8. The PIVKA-II level returned to normal after surgery and the hepatic lesions disappeared within 10 months. These findings suggest that the liver abscess stimulated cancer immunity, resulting in the proliferation of cytotoxic T lymphocytes and, subsequently, tumor regression.
一名76岁的日本男性因寒战和发热入院。计算机断层扫描显示肝脏左叶有一个10厘米的囊性肿瘤，周边有环形强化，两叶还有几个小的低密度区，周边早期强化。较大的肝脏肿块被诊断为化脓性肝脓肿，并接受了抗生素治疗。然而，肿瘤标志物异常凝血酶原（PIVKA-II）升高增加了肝细胞癌的可能性。进行了细针穿刺活检，发现了恶性肝细胞。患者接受了左半肝切除术。切除的手术标本的组织学分析证实为坏死性肝脓肿和残留的肝细胞癌，伴有大量淋巴细胞浸润。免疫组织化学分析显示淋巴细胞CD3和CD8呈阳性。术后PIVKA-II水平恢复正常，肝脏病变在10个月内消失。这些发现表明肝脓肿刺激了癌症免疫，导致细胞毒性T淋巴细胞增殖，随后肿瘤消退。
