LEP服用患者に生じたHNF-1α不活化型肝細胞腺腫の1例  [in Japanese] A case of hepatocyte nuclear factor 1α-inactivated hepatocellular adenoma associated with low-dose estrogen progestin use  [in Japanese]

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Abstract

<p>肝細胞腺腫は非硬変肝に生じるまれな良性腫瘍であり,経口避妊薬服用中の若年女性,ステロイド服用者,I型糖原病患者に発症することが多い.近年,分子病理学的に4つの亜型に分類され,診断や予後の予測に用いられるようになった.今回われわれは,月経困難症に対するLEP服用者でAIS罹患を契機に肝細胞腺腫を診断し,手術療法を施行した1例を経験したので報告する.症例は29歳,1妊0産.前医より子宮頸部細胞診異常の精査目的で当科を受診した.生検でAISの診断により子宮頸部円錐切除術を実施し,術後病理診断もAISで断端は陰性であった.全身精査のCT検査で径4.6 cmの肝内腫瘤を認めたため内科を受診した.超音波検査でS4に境界明瞭,辺縁平滑で周囲肝と等エコーを呈する内部均一な腫瘤を認めた.ソナゾイド造影超音波検査ではearly vascular phaseで腫瘤全体に不均一な早期濃染を認め,post vascular phaseで欠損を認めなかった.肝MRIで腫瘤のT1W opposed phaseはin phaseよりも信号低下を認め,腫瘤の脂肪含有が示唆された.EOB-MRIの動脈相で軽度の増強効果を示し,肝細胞相で低信号を示した.以上よりHNF-1α不活化型肝細胞腺腫が疑われた.4年前ごろより月経困難症に対してLEPを服用していたため同薬を中止した.同薬中止1年後,肝細胞腺腫の縮小を認めず,妊娠を希望したため手術の方針とした.腹腔鏡下肝S4部分切除術を実施した.病理所見は,腫瘤に被膜はなく,異型の乏しい肝細胞が索状配列を形成し,脂肪沈着を認めた.免疫組織化学染色では,腫瘍部でLFABP陰性(発現消失),背景肝でLFABP陽性であった.以上よりHNF-1α不活化型肝細胞腺腫と診断した.術後3ヵ月目に自然妊娠し,妊娠39週で合併症を伴わず経腟分娩した.LEPを長期投与する場合,肝細胞腺腫に注意する必要がある.〔産婦の進歩71(1):22-29,2019(平成31年2月)〕</p>

<p>Hepatocellular adenoma (HCA), a rare benign liver tumor, occurs particularly in women taking low-dose estrogen progestin (LEP). We report one case of hepatocyte nuclear factor 1α-inactivated (H)-HCA associated with LEP use. A 29-year-old woman was referred to our hospital for examination of abnormal cervical cytology. Histological diagnosis on conization was adenocarcinoma in situ. Computed tomography revealed a 4.6 cm liver tumor in segment 4. We suspected H-HCA as she had been taking LEP for four years, and magnetic resonance imaging showed that the tumor was hypointense on opposed phase compared with in-phase T1W images. One year after the discontinuation of LEP, the size of the tumor did not change, and she was planning to conceive. Therefore, she underwent laparoscopic partial hepatectomy of segment 4. The tumor was composed of hepatocytes without nuclear atypia, and immunohistochemically showed an absence of liver fatty acid binding protein in the tumor, but presence in the background. These findings were consistent with those of H-HCA. Three months after resection, she had a pregnancy that reached term, and she delivered without any complications. Thus, while prescribing long-term LEP, HCA should be considered. [Adv Obstet Gynecol, 71(1) : 22-29, 2019 (H31.2)]</p>

Journal

  • ADVANCES IN OBSTETRICS AND GYNECOLOGY

    ADVANCES IN OBSTETRICS AND GYNECOLOGY 71(1), 22-29, 2019

    THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN

Codes

  • NII Article ID (NAID)
    130007627110
  • NII NACSIS-CAT ID (NCID)
    AN00099490
  • Text Lang
    JPN
  • ISSN
    0370-8446
  • NDL Article ID
    029493309
  • NDL Call No.
    Z19-310
  • Data Source
    NDL  J-STAGE 
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