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以眶内转移为首发表现的肝细胞癌及其联合双免疫治疗的疗效:病例报告及文献复习。

Orbital Metastasis as the First Manifestation of Hepatocellular Carcinoma, and Its Effective Treatment with Combined Dual Immunotherapy: A Case Report and Review of the Literature.

机构信息

Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

出版信息

Am J Case Rep. 2024 Jun 3;25:e944002. doi: 10.12659/AJCR.944002.

Abstract

BACKGROUND Orbital metastasis originating from hepatocellular carcinoma (HCC), particularly as an initial manifestation in patients without a known history of HCC, is rare. Few reports exist on the treatment of patients having HCC with orbital metastasis using targeted therapy or immunotherapy. CASE REPORT We report a case of advanced-stage HCC in a 65-year-old man who first presented with progressive, painless blurred vision and proptosis of the right eye for 2 weeks. The patient had no history of chronic liver disease or cancer. Computed tomography revealed an enhancing hyperdense extraconal mass in the right orbit; a biopsy revealed metastatic HCC. Abdominal CT, which was performed to investigate the primary cancer, revealed a 1.2×1.6-cm arterial-enhancing nodule with venous washout in hepatic segment 5, associated with liver cirrhosis. The patient's serum alpha-fetoprotein level was 70.27 ng/dL. Chest computed tomography revealed lung metastasis. Thus, first-line systemic therapy combining durvalumab and tremelimumab was initiated alongside palliative radiotherapy targeting the right orbit, which began 1 week after the first dose of dual immunotherapy. The patient had significant clinical improvement, reduced proptosis, and serum alpha-fetoprotein levels. CONCLUSIONS Although orbital metastasis is a rare manifestation of HCC, physicians should recognize and consider aggressive investigations for early diagnosis, especially in patients with existing risk factors for HCC. Dual immunotherapy with durvalumab and tremelimumab in combination with radiotherapy can be considered a potential treatment option for managing advanced HCC with orbital metastasis.

摘要

背景

源于肝细胞癌(HCC)的眼眶转移,尤其是在无已知 HCC 病史的患者中作为初始表现,较为罕见。针对采用靶向治疗或免疫疗法治疗伴眼眶转移的 HCC 患者,仅有少数报道。

病例报告

我们报告了一例 65 岁男性晚期 HCC 病例,其最初表现为渐进性、无痛性视力模糊和右眼突出,持续 2 周。患者无慢性肝病或癌症病史。计算机断层扫描显示右侧眼眶内增强高密度眶外肿块;活检显示转移性 HCC。为了探究原发性癌症而进行的腹部 CT 显示肝段 5 处有 1.2×1.6cm 的动脉增强结节,伴静脉洗脱,同时存在肝硬化。患者的血清甲胎蛋白水平为 70.27ng/dL。胸部计算机断层扫描显示肺转移。因此,开始对患者进行联合度伐利尤单抗和替西木单抗的一线系统治疗,同时对右侧眼眶进行姑息性放疗,这是在双免疫治疗第一剂后 1 周开始的。患者的临床症状显著改善,眼球突出度降低,血清甲胎蛋白水平降低。

结论

尽管眼眶转移是 HCC 罕见的表现形式,但医生应认识到并考虑进行积极的检查以早期诊断,尤其是在存在 HCC 现有风险因素的患者中。对于伴眼眶转移的晚期 HCC,联合度伐利尤单抗和替西木单抗的双免疫治疗联合放疗可作为一种潜在的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c36/11163833/3f9c8eeb886d/amjcaserep-25-e944002-g001.jpg

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