一名84岁女性横结肠癌巨大肝样腺癌：病例报告及文献复习
Giant hepatoid adenocarcinoma of the transverse colon in an 84-year-old woman: A case report and review of the literature.
作者信息
Lin Chen, Wang Ziyan, Wang Peipei, Wang Qianyu, Li Mingxia, Wu Bin
机构信息
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
School of Medicine, Tsinghua University, Beijing, China.
出版信息
Medicine (Baltimore). 2025 Aug 22;104(34):e43937. doi: 10.1097/MD.0000000000043937.
RATIONALE
Hepatoid adenocarcinoma (HAC) is a rare extrahepatic tumor. The most common origin of HAC was the stomach (63%). HACs originating from the colon or rectum are rare.
PATIENT CONCERNS
An 84-year-old Chinese woman was presenting with a large abdominal mass. Imaging revealed an irregularly thickened transverse colon wall with its greatest dimension over 15 cm. Colonoscopy identified a space-occupying lesion in the transverse colon.
DIAGNOSES
Histopathology confirmed poorly differentiated adenocarcinoma with partial hepatoid differentiation.
INTERVENTIONS
The patient underwent an extended right hemicolectomy and partial small intestinal resection. Immunohistochemistry revealed mismatch repair deficiency characterized by MLH-1 and PMS-2 loss.
OUTCOMES
The patient recovered and was discharged. At 30 months of follow-up, no recurrence or metastasis was observed.
LESSONS
HACs are less likely to occur in the colorectum. We recommend that surgeons intervene aggressively if the patient's condition permits.
原理
肝样腺癌（HAC）是一种罕见的肝外肿瘤。HAC最常见的起源部位是胃（63%）。起源于结肠或直肠的HAC很罕见。
患者情况
一名84岁的中国女性因腹部巨大肿块就诊。影像学检查显示横结肠壁不规则增厚，最大径超过15厘米。结肠镜检查发现横结肠有占位性病变。
诊断
组织病理学证实为低分化腺癌伴部分肝样分化。
干预措施
患者接受了扩大右半结肠切除术和部分小肠切除术。免疫组化显示错配修复缺陷，表现为MLH-1和PMS-2缺失。
结果
患者康复出院。随访30个月，未观察到复发或转移。
经验教训
HAC在结直肠中较少见。我们建议，如果患者情况允许，外科医生应积极干预。
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