背景:肝细胞癌(HCC)肝外转移的最常见部位是肺,骨头,肾上腺,和区域淋巴结。胃肠道(GI)的血源性转移是肝癌患者的罕见疾病,预后通常较差。我们报告,在这里,一例因HCC向回肠血行转移而导致肠套叠的极为罕见的病例,以及他在多学科治疗下的长期生存。
方法:患者是一名71岁的男性,有慢性乙型肝炎病史,他接受了三次肝癌手术。他接受索拉非尼治疗肝癌腹膜转移。他因腹痛和呕吐而入院。腹部对比增强计算机断层扫描成像显示小肠肿瘤,表现为肠套叠和小肠梗阻。开始保守治疗,但由于症状反复加重,计划于住院第28d进行手术。在不减少肠套叠的情况下进行部分回肠切除和端到端吻合。在组织学检查中,在浆膜表面没有观察到肿瘤细胞,但可见肿瘤细胞血管内浸润。免疫组织化学为免疫组织化学标记阳性,并诊断为肝癌回肠血行转移。第一次手术后,他仍然活着82个月。
结论:胃肠道转移的HCC患者预后通常较差,但在某些情况下,多学科治疗可以延长生存期。
BACKGROUND: The commonest sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, bones, adrenal glands, and regional lymph nodes. Hematogenous metastasis to the gastrointestinal (GI) tract is a rare condition in patients with HCC, and the prognosis is usually poor. We report, herein, an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.
METHODS: The patient was a 71-year-old man with a history of chronic hepatitis B, who had undergone three surgeries for HCC. He was treated with sorafenib for peritoneal metastases of HCC. He was admitted to our hospital with chief complaints of abdominal pain and vomiting. Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor, presenting with intussusception and small bowel obstruction. Conservative treatment was started, but due to repeated exacerbation of symptoms, surgery was planned on the 28th d of hospitalization. Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed. On histological examination, tumor cells were not observed on the serosal surface, but intravascular invasion of tumor cells was seen. Immunohistochemistry was positive for immunohistochemical markers, and a diagnosis of hematogenous metastasis of HCC to the ileum was made. He remains alive 82 mo after the first surgery.
CONCLUSIONS: Prognosis of HCC patients with GI tract metastasis is usually poor, but in some cases, multidisciplinary therapy may prolong survival.