肉腫様変化を伴った肝細胞癌の1例  [in Japanese] HEPATOCELLULAR CARCINOMA WITH SARCOMATOUS CHANGE-A CASE REPORT-  [in Japanese]

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Abstract

症例は58歳,男性,発熱を主訴に来院した.血液生化学検査では白血球増多およびCRPの上昇を認めた.腹部超音波にて肝S4を主座とする径6cm大のhaloを有するhypoechoicな腫瘤を認めた.腹部単純CTではLDA, 造影CTでは若干不均一に造影され,腹部MRIでは, T1でlow intensity, T2でhigh intensity,ガドリニウムによる造影では不均一に造影された.腹部血管造影では腫瘤はhypovascularであった.生検では肉腫の疑いであったが, inflammatory pseudotumorや転移性肝癌も否定できなかった.手術は肝中央2区域切除術を行った.病理組織所見では主として紡錘形の異型細胞からなり,免疫染色ではvimentinのみ陽性であったが,所々でsinusoidal patternがみられることより肉腫様変化を伴った肝細胞癌と診断された.<br> 本疾患は術前診断が難しい上予後が極めて悪いため早期発見,早期手術が望まれる.

A 58-year-old man was seen at the hospital because of fever. On a blood biochemical study, increases in white blood cell count and CRP were noted. Abdominal ultrasonography revealed a hypoechoic tumor 6cm in diameter with halo mainly situating in the S4 of liver. It was visualized as LDA and somewhat heterogeneous mass on an abdominal plain CT and an enhanced CT scans, respectively. On abdominal magnetic resonance imaging (MRI) scans, Tl-weighted, T2-weighted, and Ga visualized a heterogeneous tumor. Abdominal angiography revealed a hypovascular tumor. Sarcoma was suspected by a biopsy, but a possibility of inflammatory pseudotumor or metastatic hepatic cancer could not be ruled out. A medial disegmentectomy of liver was performed. The tumor was mainly composed of spindle atypical cells histopathologically. It showed a positive reaction to vimentin only at immunological stainings, but sinusoidal pattern was observed in places. Consequently, hepatocellular carcinoma with sarcomatous change was diagnosed.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(4), 972-977, 2002-04-25

    Japan Surgical Association

References:  12

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008619100
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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