Mitsunobu M, Toyosaka A, Oriyama T, Okamoto E, Nakao N
First Department of Surgery, Hyogo College of Medicine, Japan.
Clin Exp Metastasis. 1996 Nov;14(6):520-9. doi: 10.1007/BF00115112.
The mechanism and pathogenesis of the high frequency of intrahepatic metastasis in hepatocellular carcinoma (HCC) has not yet been elucidated. Two hundred and thirty one tumors (< or = 5 cm in diameter) of resected specimens of HCC were examined for the relationship between mode of tumor spread and tumor size. Efferent vessels in HCC were identified by direct injection of radiopaque material into the tumor in 23 resected liver specimens selected at random from the 231 tumors. The most frequent site for tumor spread in HCC was capsular invasion followed by extracapsular invasion, vascular invasion, and finally intrahepatic metastasis. There was a strong statistical correlation between the presence of intrahepatic metastasis and the frequency of vascular invasion (correlation coefficient = 0.998). Radiopaque material injected directly into 23 resected tumors entered only the portal vein in 17 tumors and into both the portal and hepatic veins in six tumors. In all eight patients with unresectable lesions, radiopaque media injected percutaneously into tumor nodules flowed only into the portal vein. These findings suggest that tumor spread in HCC progresses from capsular invasion to intrahepatic invasion and that the portal vein may act as an efferent tumor vessel.
肝细胞癌（HCC）肝内转移高发的机制和发病机理尚未阐明。对231例直径小于或等于5cm的HCC切除标本肿瘤进行了肿瘤播散方式与肿瘤大小关系的研究。从231例肿瘤中随机选取23例切除的肝标本，通过向肿瘤内直接注射不透射线的物质来识别HCC的输出血管。HCC肿瘤播散最常见的部位是包膜侵犯，其次是包膜外侵犯、血管侵犯，最后是肝内转移。肝内转移的存在与血管侵犯频率之间存在很强的统计学相关性（相关系数=0.998）。直接注入23例切除肿瘤的不透射线物质，17例肿瘤仅进入门静脉，6例肿瘤进入门静脉和肝静脉。在所有8例无法切除病变的患者中，经皮注入肿瘤结节的不透射线介质仅流入门静脉。这些发现表明，HCC的肿瘤播散从包膜侵犯发展到肝内侵犯，门静脉可能作为肿瘤的输出血管。
