Arito Midori, Terada Takuro, Yamada Sho, Nakayama Takashi, Munemoto Yoshinori, Mitsui Takeshi
Department of Surgery, Fukui Prefectural Saiseikai Hospital, 7-1, Funabashi, Wadanakamachi, Fukui, Fukui, 918-8503, Japan.
Department of Oncology, Fukui Prefectural Saiseikai Hospital, 7-1, Funabashi, Wadanakamachi, Fukui, Fukui, 918-8503, Japan.
Clin J Gastroenterol. 2025 Aug 25. doi: 10.1007/s12328-025-02210-2.
An 82-year-old man underwent follow-up evaluations for a lung tumor in the right lower lobe in 2018. In 2019, computed tomography (CT) revealed an irregularly elevated tumor in liver segment S8, which was diagnosed as hepatocellular carcinoma (HCC) with inferior vena cava thrombus. Proton therapy was initially performed for the HCC. In 2020 and 2021, transcatheter arterial chemoembolization (TACE) was performed for liver recurrence. In 2022, CT showed a portal vein thrombus, lymph node metastasis from the pancreatic head tumor, and duodenal metastasis from HCC. The patient then underwent chemotherapy. During chemotherapy, transfusion and superior inferior pancreaticoduodenal artery embolization were performed for bleeding from duodenal metastasis. After chemotherapy, CT showed complete remission of the portal vein thrombus and lymph node metastasis. The duodenal metastasis had grown. In 2023, we performed subtotal gastric-sparing pancreaticoduodenectomy for duodenal metastasis. A pathological examination revealed duodenal metastasis from HCC and no exposure to the serosa, although there was some infiltration outside the muscularis propria. The patient remains well with no evidence of tumor recurrence 1 year after resection. We suggest that resection of duodenal metastases may not only control bleeding, but also improve the prognosis through local control.
一名82岁男性于2018年接受了右下叶肺部肿瘤的随访评估。2019年，计算机断层扫描（CT）显示肝S8段有一个不规则隆起的肿瘤，诊断为肝细胞癌（HCC）伴下腔静脉血栓形成。最初对该HCC进行了质子治疗。2020年和2021年，对肝复发进行了经导管动脉化疗栓塞术（TACE）。2022年，CT显示门静脉血栓形成、胰头肿瘤的淋巴结转移以及HCC的十二指肠转移。患者随后接受了化疗。化疗期间，对十二指肠转移引起的出血进行了输血和胰十二指肠上下动脉栓塞术。化疗后，CT显示门静脉血栓形成和淋巴结转移完全缓解。十二指肠转移灶增大。2023年，我们对十二指肠转移灶进行了保留大部分胃的胰十二指肠切除术。病理检查显示为HCC的十二指肠转移，未累及浆膜，尽管固有肌层外有一些浸润。患者术后1年情况良好，无肿瘤复发迹象。我们认为，十二指肠转移灶的切除不仅可以控制出血，还可以通过局部控制改善预后。
