Tsai G L, Liu J D, Siauw C P, Chen P H
Chest. 1984 Sep;86(3):430-4. doi: 10.1378/chest.86.3.430.
The most common extrahepatic metastasis of primary carcinoma of the liver is pulmonary metastasis. The discrepancy in the incidence of metastasis between clinical and postmortem series is quite obvious. The rapidly fatal course of hepatoma, the limitations of the chest x-ray film in detecting the small implantation, and incomplete follow-up of patients lead to the lower incidence in clinical series. From January 1974 to December 1982, there were 470 cases of primary carcinoma of the liver at Taipei Municipal Jen-Ai Hospital. Among them, we found 439 cases of hepatocellular carcinoma and 31 cases of cholangiocellular carcinoma. We also found 50 cases (11 percent) of hepatocellular carcinoma with pulmonary metastasis and ten cases (2 percent) of hepatocellular carcinoma with bone metastasis. Seven of the ten cases of bone metastasis were intrathoracic. Additionally, we found that it was rare to have pulmonary metastasis in cholangiocellular carcinoma; it only occurred once. Hematogenous and lymphatic spread and direct invasion are the principal ways for metastasis in primary hepatoma. Multiple nodulation and pleural effusion are the main manifestations in the chest x-ray film. Additionally, we saw lymphangitic carcinomatosis and miliary lesions in some of our patients. The common characteristic of these metastases is that most of the lesions arise from or are prominent in the right lower pulmonary field. Osteolysis appears in the patients with bone metastasis. Most of the metastases form a big protruding mass of tumor.
原发性肝癌最常见的肝外转移是肺转移。临床系列与尸检系列中转移发生率的差异相当明显。肝癌的快速致命病程、胸部X光片在检测小种植灶方面的局限性以及患者随访的不完整导致临床系列中的发生率较低。1974年1月至1982年12月，台北市仁爱医院有470例原发性肝癌病例。其中，我们发现439例肝细胞癌和31例胆管细胞癌。我们还发现50例（11%）肝细胞癌伴有肺转移，10例（2%）肝细胞癌伴有骨转移。10例骨转移病例中有7例是胸内转移。此外，我们发现胆管细胞癌发生肺转移很罕见，仅发生过1次。血行和淋巴转移以及直接侵犯是原发性肝癌转移的主要途径。多发结节和胸腔积液是胸部X光片的主要表现。此外，我们在一些患者中还看到了淋巴管癌病和粟粒状病变。这些转移的共同特点是大多数病变起源于右下肺野或在右下肺野较为突出。骨转移患者出现骨质溶解。大多数转移灶形成一个大的突出肿瘤块。
