复发性肝细胞癌(HCC)在肝移植后提出了重大挑战,影响约10-23%的患者,中位发病时间为移植后13个月。肝外受累,比如肺,骨头,肾上腺,腹膜,淋巴结,中枢神经系统(CNS),在肝癌复发的移植受者中常见。值得注意的是,血管浸润(VI),包括微血管侵犯(MiVI)和大血管侵犯(MVI),将复发风险大幅增加2.42倍和7.82倍,分别。本文介绍了一名72岁男性患者的独特病例,该患者有HCV相关性肝硬化和HCC病史,接受了原位肝移植(OLT)。六年后,跌倒后他向急诊科介绍,这导致在成像过程中发现了T7的病理性骨折和偶然的颅内肿块。随后的活检证实T7病变中的转移性HCC,而磁共振成像显示两个增强的脑部肿块。左侧枕颞叶有一个4.8厘米的肿块,另一个在右额回测量1.7厘米。值得注意的是,患者在OLT时表现出MiVI,甲胎蛋白水平(AFP)轻度升高7.6ng/mL.该病例强调了MiVI在OLT后HCC复发中的预测价值。因此,延长移植后监测对HCC和MiVI患者至关重要.此外,本报告强调了HCC患者OLT后迟发性脑转移的罕见发生。
Recurrent hepatocellular carcinoma (HCC) poses a significant challenge after liver transplantation, affecting approximately 10-23% of patients with a median onset of 13 months post-transplantation. Extrahepatic involvement, such as lung, bone, adrenal glands, peritoneum, lymph nodes, and central nervous system (CNS), is commonly observed among transplant recipients with HCC recurrence. Notably, vascular invasion (VI), including microvascular invasion (MiVI) and macrovascular invasion (MVI), substantially increase the risk of recurrence by 2.42- and 7.82-fold, respectively. This article presents a unique
case of a 72-year-old male patient with a history of HCV-related cirrhosis and HCC who underwent orthotopic liver transplantation (OLT). Six years later, he presented to the emergency department following a fall, which led to the discovery of a pathologic fracture of T7 and an incidental intracranial mass during imaging. Subsequent biopsy confirmed metastatic HCC in the T7 lesion, while magnetic resonance imaging revealed two enhancing brain masses. One mass measured 4.8 cm in the left occipitotemporal lobe, and the other measured 1.7 cm in the right frontal gyrus. Notably, the patient had exhibited MiVI and a mildly elevated alpha-fetoprotein level (AFP) of 7.6 ng/mL at the time of his OLT. This
case underscores the predictive value of MiVI in HCC recurrence post-OLT. Accordingly, extended post-transplantation surveillance is crucial for patients with HCC and MiVI. Moreover, this report highlights the uncommon occurrence of delayed brain metastasis following OLT in a patient with HCC.