内容紹介
Summary
The patient was a 55-year-old man who had undergone extended right lobectomy of the liver with a diagnosis of primary hepatic carcinoid tumor. Nine years after the operation, enhanced abdominal CT revealed a tumor measuring 2.2 cm in the remnant liver. He was diagnosed with recurrence of primary hepatic neuroendocrine carcinoma and underwent partial hepatectomy. Pathologically, the tumor cells had round nuclei and formed trabecular patterns. Immunohistologically, the cells were positive for CD56, synaptophysin, and chromogranin A. The Ki-67 index was 6%, which was equivalent to Grade 2 in the WHO classification revised in 2010. Since there were no other lesions suspected to be the primary site other than in the liver, it was diagnosed as recurrence of the primary hepatic neuroendocrine carcinoma. Two years after the operation, he was diagnosed with recurrence of primary hepatic neuroendocrine carcinoma and underwent partial hepatectomy again.
要旨
肝原発神経内分泌腫瘍はまれである。われわれは,以前に肝原発カルチノイド症例を報告した。原発巣切除後9年目以降に二度の再発を来し,再肝切除を施行したので報告する。症例は55歳,男性。2007年に拡大肝右葉切除術を施行し,肝カルチノイドと診断された。2016年2月に肝S3への再発を認め,肝部分切除術を施行した。2018年8月にも肝S4に再発所見を認め,再度肝切除術を施行した。いずれも病理組織学的検査において,再発性肝神経内分泌腫瘍G2に相当するとの診断であった。神経内分泌腫瘍の既往がある患者においては,本症例のように術後長期間経過後の再発や転移を生じる可能性があり,長期的な術後観察が必要であると考えられる。
目次
The patient was a 55-year-old man who had undergone extended right lobectomy of the liver with a diagnosis of primary hepatic carcinoid tumor. Nine years after the operation, enhanced abdominal CT revealed a tumor measuring 2.2 cm in the remnant liver. He was diagnosed with recurrence of primary hepatic neuroendocrine carcinoma and underwent partial hepatectomy. Pathologically, the tumor cells had round nuclei and formed trabecular patterns. Immunohistologically, the cells were positive for CD56, synaptophysin, and chromogranin A. The Ki-67 index was 6%, which was equivalent to Grade 2 in the WHO classification revised in 2010. Since there were no other lesions suspected to be the primary site other than in the liver, it was diagnosed as recurrence of the primary hepatic neuroendocrine carcinoma. Two years after the operation, he was diagnosed with recurrence of primary hepatic neuroendocrine carcinoma and underwent partial hepatectomy again.
要旨
肝原発神経内分泌腫瘍はまれである。われわれは,以前に肝原発カルチノイド症例を報告した。原発巣切除後9年目以降に二度の再発を来し,再肝切除を施行したので報告する。症例は55歳,男性。2007年に拡大肝右葉切除術を施行し,肝カルチノイドと診断された。2016年2月に肝S3への再発を認め,肝部分切除術を施行した。2018年8月にも肝S4に再発所見を認め,再度肝切除術を施行した。いずれも病理組織学的検査において,再発性肝神経内分泌腫瘍G2に相当するとの診断であった。神経内分泌腫瘍の既往がある患者においては,本症例のように術後長期間経過後の再発や転移を生じる可能性があり,長期的な術後観察が必要であると考えられる。