PDF(Pubmed)
Abstract：
Hepatic angiomyolipoma is a rare and possibly cancerous mesenchymal tumor that consists of three components: blood vessels, smooth muscle cells, and adipose tissue. In this paper, we reported a case of a 36-year-old man who had a giant hepatic angiomyolipoma with spontaneous rupture and hemorrhage. The patient was admitted to our hospital with sudden upper abdominal pain for 3 h. A giant tumor was found in the left and caudate lobes of the liver, as well as significant blood collection around the liver and in the pelvis. Hemoglobin, liver function test results, and serum tumor maker levels were all within normal ranges. To prevent bleeding, emergency angiography and embolization were performed. During angiography, it was discovered that the tumor was supplied by the left hepatic artery and had a very rich internal blood supply. A massive left hepatic mass of about 11 cm in diameter was found bulging from the surface of the liver and rupturing there during laparoscopic exploration a week later. The rupture was strongly adhered to the smaller curvature of the stomach. The patient underwent laparoscopic left hemihepatectomy and caudate lobectomy, and the tumor specimen was brown, with clear boundaries with the surrounding normal liver parenchyma, and there were a large number of necrotic lesions inside the tumor. Histopathological results confirmed the mass as hepatic angiomyolipoma with negative resection margins. Immunohistochemical staining indicated that the tumor had positive homatropine methylbromide-45. After 13 months of follow-up, no tumor recurrence or metastasis occurred in the patient.
摘要：
肝血管平滑肌脂肪瘤是一种罕见的，可能是癌性的间质瘤，由三个部分组成：血管，平滑肌细胞，和脂肪组织。在本文中,我们报道了一例36岁的男性患者，他患有巨大的肝血管平滑肌脂肪瘤并自发性破裂和出血。患者因突发性上腹痛3小时入院。在肝脏的左侧和尾状叶发现了一个巨大的肿瘤，以及肝脏和骨盆周围的大量血液收集。血红蛋白,肝功能检查结果,血清肿瘤标志物水平均在正常范围内。为了防止出血,进行了紧急血管造影和栓塞。在血管造影期间,发现肿瘤由左肝动脉供应，内部血液供应非常丰富。在一周后的腹腔镜探查中，发现一个直径约11厘米的巨大左肝肿块从肝脏表面凸出并在那里破裂。破裂强烈地粘附在胃的较小曲率上。患者行腹腔镜左半肝切除术和尾状叶切除术,肿瘤标本是棕色的，与周围正常肝实质有明确的界限，肿瘤内有大量坏死性病变。组织病理学结果证实肿块为肝血管平滑肌脂肪瘤，切缘阴性。免疫组织化学染色显示肿瘤阳性的甲基溴-45。经过13个月的随访，患者无肿瘤复发或转移。
