Schwarzbach M, Willeke F, Hoffmann V, Mechtersheimer G, Otto G
Chirurgische Klinik, Ruprecht-Karls-Universität Heidelberg.
Dtsch Med Wochenschr. 1997 Apr 4;122(14):439-44. doi: 10.1055/s-2008-1047635.
In a 34-year-old woman who underwent ultrasound investigation because of recurrent pyelonephritis a space-occupying lesion in the liver was an incidental finding. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a tumour in segment I of the liver. The patient had been on contraceptives for 12 years. She had no symptoms.
Laboratory tests, including tumour markers, were unremarkable. Diagnostic tests to exclude malignant tumour with metastases were negative (thyroid scintigraphy, mammography, coloscopy and gastroscopy). Further tests (ultrasound, coeliaco-mesentericography, hydro-CT and spiral CT, MRI) revealed a tumour, 5 x 4 x 4 cm, in segment I of the liver, most likely an adenoma. Surgical intervention was indicated by the size and questionable malignancy of the tumor.
At operation a tumour was found which originated from the inferior vena cava (IVC) and displaced segment I of the liver. The tumour was resected and the venous wall reconstructed with a Goretex patch. Histological examination indicated a poorly differentiated leiomyosarcoma of the IVC. Adjuvant radiotherapy was undertaken postoperatively. There has been no evidence of recurrence after 10 months.
Leiomyosarcoma of the IVC can be mistaken, both by ultrasound and tomographic diagnostic procedures, for a tumour in segment I of the liver, especially an adenoma. A leiomyosarcoma of the IVC should be included in the differential diagnosis of an hepatic tumour that lies close to segment I of the liver.
一名34岁女性因复发性肾盂肾炎接受超声检查时，偶然发现肝脏有占位性病变。计算机断层扫描（CT）和磁共振成像（MRI）证实肝脏Ⅰ段有肿瘤。该患者已服用避孕药12年，无任何症状。
包括肿瘤标志物在内的实验室检查无异常。排除伴有转移的恶性肿瘤的诊断性检查结果均为阴性（甲状腺闪烁扫描、乳房X线摄影、结肠镜检查和胃镜检查）。进一步检查（超声、腹腔肠系膜血管造影、增强CT和螺旋CT、MRI）显示肝脏Ⅰ段有一个5×4×4cm的肿瘤，很可能是腺瘤。鉴于肿瘤大小及可疑的恶性程度，需进行手术干预。
手术中发现肿瘤起源于下腔静脉（IVC）并推移了肝脏Ⅰ段。切除肿瘤后，用戈尔特斯补片重建静脉壁。组织学检查显示为IVC低分化平滑肌肉瘤。术后进行了辅助放疗。10个月后未发现复发迹象。
IVC平滑肌肉瘤在超声和断层诊断程序中都可能被误诊为肝脏Ⅰ段的肿瘤，尤其是腺瘤。IVC平滑肌肉瘤应纳入靠近肝脏Ⅰ段的肝肿瘤的鉴别诊断。
