McCormick S E, Sjogren M H, Goodman Z D
Gastroenterology Department, Walter Reed Army Medical Center, Washington, DC 20307-5001.
Semin Liver Dis. 1994 Nov;14(4):395-403. doi: 10.1055/s-2007-1007330.
Our patient presented with a large liver mass, an extremely elevated AFP level, and an almost certain diagnosis of HCC. However, extensive evaluation and biopsies failed to demonstrate malignancy, and the available evidence strongly suggests that the patient has an adult polycystic disease without renal involvement, and that the mass was the result of hemorrhage and degenerative changes in one of his cysts. Polycystic diseases can involve only one lobe, as it appears in this case. Only about 10-15% of patients with polycystic disease have symptoms due to the liver disease, while 30-50% have associated renal disease. Thus, our patient is unusual in several respects. However, his liver mass has decreased in size, he feels well, and his biochemical abnormalities have returned to normal. Despite a classic presentation for HCC, this case underscores the necessity for a thorough evaluation, especially for patients without major risk factors for hepatocellular carcinoma.
我们的患者表现为肝脏有一个大肿块、甲胎蛋白水平极度升高，几乎可以确诊为肝癌。然而，全面评估和活检均未发现恶性肿瘤，现有证据强烈表明该患者患有成人多囊病且未累及肾脏，肿块是其一个囊肿出血和退行性变的结果。多囊病可能仅累及一个肝叶，就像本例所示。多囊病患者中只有约10% - 15%因肝脏疾病出现症状，而30% - 50%伴有肾脏疾病。因此，我们的患者在几个方面都不寻常。不过，他肝脏肿块的大小已缩小，感觉良好，生化指标异常也已恢复正常。尽管该病例有典型的肝癌表现，但它强调了全面评估的必要性，尤其是对于没有肝细胞癌主要危险因素的患者。
