不明原发性肝癌肝肋膜外转移的罕见疑难病例。

Q3 Medicine
Christophe-Karl Souaid, Olivier Marty, Cynthia Medlij
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引用次数: 0

摘要

肝细胞癌(HCC)通常表现为原发性肝肿块。然而,在极少数情况下,最初的表现可能完全与肝外转移有关,最常见的转移部位是肺、淋巴结、骨骼和肾上腺。骨转移通常伴有身体其他部位的多发性转移扩散或既往诊断的 HCC,但也有单发骨转移且影像学检查无肝脏病变的病例报道。事实上,文献中已经报道了两种罕见的 HCC 实体,即异位肝细胞癌和浸润型肝细胞癌,这两种类型的肝细胞癌在放射学诊断上极具挑战性,且预后较差。本文中,我们介绍了一例肝细胞癌肝肋骨外转移病例,该病例通过骨活检确诊,肝脏影像学检查(包括超声、多相核磁共振成像和 CT 扫描)除门静脉血栓外,无局灶病变。在评估慢性肝病患者快速增长的肝外病变时,必须考虑 HCC 转移的可能性,并考虑肿瘤特征、影像学检查结果以及局限性,以便及时做出准确诊断,改善患者管理。我们的患者很可能是浸润性 HCC,因为有两个突出因素:门静脉血栓和甲胎蛋白(AFP)明显升高。肝活检对于确诊至关重要,但遗憾的是,由于患者因失血性休克意外死亡,活检未能进行。值得注意的是,在这个病例中,甲胎蛋白的升高引起了人们对潜在的肝癌的怀疑,并促成了更精细的诊断检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A rare and challenging case of extrahepatic costal metastases from an unknown primary hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) typically presents with a primary hepatic mass. Nevertheless, on rare occasions, the initial presentation can be exclusively related to extrahepatic metastases and the most common sites of metastases are the lungs, lymph nodes, bones, and adrenal glands. While, bone metastases are generally accompanied by multiple metastatic spreads elsewhere in the body or previously diagnosed HCC, cases of solitary bone metastases with no liver lesion at imaging have been reported. Indeed, two rare entities of HCC have been reported in the literature which are the ectopic hepatocellular carcinoma and the infiltrative type of hepatocellular carcinoma with a very challenging radiologic diagnosis and poor prognosis. In this article, we present a case of extrahepatic costal metastases of hepatocellular carcinoma, which was diagnosed through a bone biopsy, with no focal lesion on liver imaging including ultrasound, multiphase MRI, and CT scan except for the presence of a portal vein thrombosis. It is important to consider the possibility of HCC metastases when evaluating rapidly growing extrahepatic lesions in patients with chronic liver disease and to consider the tumor characteristics and imaging findings as well as limitations to make accurate and timely diagnosis leading to improved patient management. Our patient had probably an infiltrating HCC because of two prominent factors: the presence of portal vein thrombosis and a markedly elevated alpha-fetoprotein (AFP). A liver biopsy was crucial in order to confirm the diagnosis but unfortunately it could not be performed because of the unexpected death of the patient due to hemorrhagic shock. It is also worth noting in this case, that the elevated level of AFP raised the suspicion on an underlying HCC and contributed to more elaborate diagnostic tests.

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来源期刊
CiteScore
2.30
自引率
0.00%
发文量
29
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