内容紹介
Summary
The patient was a 62-year-old man with no specific medical history. Lateral segmentectomy was performed for hepatocellular carcinoma with a tumor size of approximately 14×13 cm. The histopathological diagnosis was moderately differentiated hepatocellular carcinoma: Fc(-), Fc-Inf(-), Sf(-), S0, N0, Vp2, Vv1, Va0, B0, P0, SM(-), CH. Five years after the first surgery, computed tomography(CT)revealed a left lung tumor in segment 9/10 and left lymph nodes; thus, left pneumonectomy was performed, and these tumors were identified to have metastasized from the primary tumor. Six years after the first surgery, his serum alpha-fetoprotein level was remarkably elevated from 254.9 ng/mL to 3,143.0 ng/mL for three months, and at the same time, he developed left meralgia and swelling of the left femur. Magnetic resonance imaging showed a high-density mass(30×14 cm)in the left quadriceps, and positron emission tomography-CT revealed high uptake in the left quadriceps with a maximum standardized uptake value of 12.3. A needle biopsy of the left femur tumor confirmed metastasis from the primary tumor. Radiotherapy was administered because general anesthesia can prove to be hazardous due to the patient having undergone left pneumonectomy.
要旨
症例は62歳,男性。14×13 cm大の早期濃染,wash outを伴う肝外側区域の肝細胞癌に対して肝外側区域切除術を施行した。病理組織検査の結果は,moderately differentiated hepatocellular carcinoma,Eg,Fc(-),Fc-Inf(-),Sf(-),S0,N0,Vp2,Vv1,Va0,B0,P0,SM(-),CHであった。術後5年目,胸部CT検査にて左肺S9/10に境界明瞭な5 cm大の腫瘍と左肺門リンパ節の腫脹を認め,肺転移が疑われ左肺全摘術を施行した。病理組織検査の結果は,肝細胞癌の肺転移であった。初回手術から6年後,α-fetoproteinが3か月間で254.9 ng/mLから3,143.0 ng/mLへと急上昇し,左大腿部の腫脹と疼痛も出現した。MRI検査にて左大腿四頭筋を中心とする境界明瞭な30×14 cm大の巨大な充実性腫瘍を認め,左大腿四頭筋の腫瘤に対して針生検を施行したところ原発の肝細胞癌に類似する所見を認め,筋転移と診断された。左肺全摘術後であり,全身麻酔のリスクが高いことから放射線治療の方針となった。肝細胞癌術後急速に増大傾向を示した巨大血行性左大腿四頭筋転移の1例を経験した。
目次
The patient was a 62-year-old man with no specific medical history. Lateral segmentectomy was performed for hepatocellular carcinoma with a tumor size of approximately 14×13 cm. The histopathological diagnosis was moderately differentiated hepatocellular carcinoma: Fc(-), Fc-Inf(-), Sf(-), S0, N0, Vp2, Vv1, Va0, B0, P0, SM(-), CH. Five years after the first surgery, computed tomography(CT)revealed a left lung tumor in segment 9/10 and left lymph nodes; thus, left pneumonectomy was performed, and these tumors were identified to have metastasized from the primary tumor. Six years after the first surgery, his serum alpha-fetoprotein level was remarkably elevated from 254.9 ng/mL to 3,143.0 ng/mL for three months, and at the same time, he developed left meralgia and swelling of the left femur. Magnetic resonance imaging showed a high-density mass(30×14 cm)in the left quadriceps, and positron emission tomography-CT revealed high uptake in the left quadriceps with a maximum standardized uptake value of 12.3. A needle biopsy of the left femur tumor confirmed metastasis from the primary tumor. Radiotherapy was administered because general anesthesia can prove to be hazardous due to the patient having undergone left pneumonectomy.
要旨
症例は62歳,男性。14×13 cm大の早期濃染,wash outを伴う肝外側区域の肝細胞癌に対して肝外側区域切除術を施行した。病理組織検査の結果は,moderately differentiated hepatocellular carcinoma,Eg,Fc(-),Fc-Inf(-),Sf(-),S0,N0,Vp2,Vv1,Va0,B0,P0,SM(-),CHであった。術後5年目,胸部CT検査にて左肺S9/10に境界明瞭な5 cm大の腫瘍と左肺門リンパ節の腫脹を認め,肺転移が疑われ左肺全摘術を施行した。病理組織検査の結果は,肝細胞癌の肺転移であった。初回手術から6年後,α-fetoproteinが3か月間で254.9 ng/mLから3,143.0 ng/mLへと急上昇し,左大腿部の腫脹と疼痛も出現した。MRI検査にて左大腿四頭筋を中心とする境界明瞭な30×14 cm大の巨大な充実性腫瘍を認め,左大腿四頭筋の腫瘤に対して針生検を施行したところ原発の肝細胞癌に類似する所見を認め,筋転移と診断された。左肺全摘術後であり,全身麻酔のリスクが高いことから放射線治療の方針となった。肝細胞癌術後急速に増大傾向を示した巨大血行性左大腿四頭筋転移の1例を経験した。