内容紹介
A Case of Repeated Surgical Resections for Tumor Seeding of Hepatocellular Carcinoma after Radiofrequency Ablation
Summary
We report a case of repeated surgical resections for the tumor seeding of hepatocellular carcinoma(HCC)after radiofrequency ablation(RFA). A 79-year-old man, who had an intrahepatic recurrence of HCC(segment 2)5 months after RFA, was referred to our hospital for surgery, and underwent a laparoscopic lateral segmentectomy. Histological examination showed a poorly differentiated HCC(pStageⅡ). Eight months after RFA, subcutaneous nodules along the RFA needle tract were pointed out by abdominal CT, and a tumorectomy was performed. Nineteen months after RFA, abdominal CT showed a 33 mm tumor on the side of the spleen, leading to the diagnosis of the peritoneal dissemination following RFA. The tumor has been growing up to 49 mm in size in spite of a radiation therapy. Accordingly, a laparoscopic tumorectomy was performed 26 months after RFA. His resected tumors were morphologically identical to the intrahepatic recurrence of HCC. The patient had remained recurrence-free for 4 months after the second tumorectomy. Our case demonstrated the utility of surgical resection for the tumor seeding of HCC following RFA.
要旨
肝細胞癌に対するラジオ波焼灼治療(RFA)後の穿刺経路播種および腹腔内播種に対して外科的切除を施行した1例を経験した。症例は79歳,男性。初発肝細胞癌(S2/3)に対するRFA施行5か月後に肝内再発(S2)を認めた。手術目的に当科紹介となり,腹腔鏡下肝外側区域切除術を施行した。病理組織学的には,低分化型肝細胞癌(pStageⅡ)であった。RFA施行8か月後の腹部CTにてRFA穿刺経路に一致した皮下に小結節を複数個認め,穿刺経路播種の診断にて皮下腫瘤摘出術を施行した。さらにRFA施行19か月後の腹部CTにて脾門部に結節(33 mm)を認め,腹腔内播種と診断した。放射線療法を行うも腫瘤は増大傾向(49 mm)であり,RFA施行26か月後に腹腔鏡下播種結節摘出術を施行した。病理組織学的には,いずれも肝内病巣に類似した組織像を呈していた。腹腔内播種結節摘出後4か月が経過し,無再発生存中である。RFA後の腫瘍播種に対する積極的な外科的局所制御は有効であると思われた。
目次
Summary
We report a case of repeated surgical resections for the tumor seeding of hepatocellular carcinoma(HCC)after radiofrequency ablation(RFA). A 79-year-old man, who had an intrahepatic recurrence of HCC(segment 2)5 months after RFA, was referred to our hospital for surgery, and underwent a laparoscopic lateral segmentectomy. Histological examination showed a poorly differentiated HCC(pStageⅡ). Eight months after RFA, subcutaneous nodules along the RFA needle tract were pointed out by abdominal CT, and a tumorectomy was performed. Nineteen months after RFA, abdominal CT showed a 33 mm tumor on the side of the spleen, leading to the diagnosis of the peritoneal dissemination following RFA. The tumor has been growing up to 49 mm in size in spite of a radiation therapy. Accordingly, a laparoscopic tumorectomy was performed 26 months after RFA. His resected tumors were morphologically identical to the intrahepatic recurrence of HCC. The patient had remained recurrence-free for 4 months after the second tumorectomy. Our case demonstrated the utility of surgical resection for the tumor seeding of HCC following RFA.
要旨
肝細胞癌に対するラジオ波焼灼治療(RFA)後の穿刺経路播種および腹腔内播種に対して外科的切除を施行した1例を経験した。症例は79歳,男性。初発肝細胞癌(S2/3)に対するRFA施行5か月後に肝内再発(S2)を認めた。手術目的に当科紹介となり,腹腔鏡下肝外側区域切除術を施行した。病理組織学的には,低分化型肝細胞癌(pStageⅡ)であった。RFA施行8か月後の腹部CTにてRFA穿刺経路に一致した皮下に小結節を複数個認め,穿刺経路播種の診断にて皮下腫瘤摘出術を施行した。さらにRFA施行19か月後の腹部CTにて脾門部に結節(33 mm)を認め,腹腔内播種と診断した。放射線療法を行うも腫瘤は増大傾向(49 mm)であり,RFA施行26か月後に腹腔鏡下播種結節摘出術を施行した。病理組織学的には,いずれも肝内病巣に類似した組織像を呈していた。腹腔内播種結節摘出後4か月が経過し,無再発生存中である。RFA後の腫瘍播種に対する積極的な外科的局所制御は有効であると思われた。