内容紹介
Summary
Most solitary fibrous tumors(SFT)occur in the thoracic cavity and reports on liver SFT are very rare. We encountered a case of SFT of the liver, and thus, decided to report it with a review of literature. A 70-year-old man was informed of a liver tumor by his previous doctor and referred to us for further examination and treatment. Contrast-enhanced CT revealed a 3.5 cm cyst in the S2/3 of the liver and a 3.2 cm tumor with an early staining within the cyst. Laparoscopic lateral segmentectomy was performed and a diagnosis of hepatic cystic adenocarcinoma was made. Macroscopically, the tumor was white and well-defined. Histopathological examination revealed round chromatin-enriched tumor cells proliferated with round fibrillar cells or intercalated structures consisting of round or short spindle-shaped cells. Immunohistochemistry yielded negative results for CAM5.2, HepPar1, CD31, CD99, SMA, and HMB45 but positive results for CD34, Factor Ⅷ, Bcl-2, and STAT6; therefore, the patient was further diagnosed with liver SFT. Although liver SFT is rare, it was considered a differential diagnosis when multiple bloody liver tumors were detected. In addition, since there were reports of recurrence, careful follow-up in future, was deemed necessary.
要旨
孤立性線維性腫瘍(solitary fibrous tumor: SFT)の多くは胸腔内に発生し,肝臓原発のSFTの報告は非常にまれである。今回われわれは,肝臓原発SFTの1例を経験したので文献的考察を加えて報告する。症例は70歳,男性。前医で肝腫瘍を指摘され,精査加療目的に当科紹介となった。造影CTで肝S2/3に3.5 cm大の囊胞と,囊胞内に早期濃染を伴う3.2 cm大の腫瘍を認め,肝囊胞性腺癌の診断で腹腔鏡下肝外側区域切除術を行った。肉眼的には白色の境界明瞭な腫瘍であった。病理組織学的検査では類円形または短紡錘形細胞で,核クロマチンの増量した腫瘍細胞が膠原線維や血管腔様構造の介在を伴って増殖していた。免疫染色でCAM5.2,HepPar1,CD31,CD99,SMA,HMB45が陰性,CD34,Factor Ⅷ,Bcl-2,STAT6が陽性であったことから,肝臓原発SFTと診断した。肝臓原発SFTはまれな腫瘍であるが,多血性肝腫瘍を認めた際には鑑別疾患として考慮すべきと思われた。また,再発の報告もあることから今後も慎重な経過観察が必要と考えられた。
目次
Most solitary fibrous tumors(SFT)occur in the thoracic cavity and reports on liver SFT are very rare. We encountered a case of SFT of the liver, and thus, decided to report it with a review of literature. A 70-year-old man was informed of a liver tumor by his previous doctor and referred to us for further examination and treatment. Contrast-enhanced CT revealed a 3.5 cm cyst in the S2/3 of the liver and a 3.2 cm tumor with an early staining within the cyst. Laparoscopic lateral segmentectomy was performed and a diagnosis of hepatic cystic adenocarcinoma was made. Macroscopically, the tumor was white and well-defined. Histopathological examination revealed round chromatin-enriched tumor cells proliferated with round fibrillar cells or intercalated structures consisting of round or short spindle-shaped cells. Immunohistochemistry yielded negative results for CAM5.2, HepPar1, CD31, CD99, SMA, and HMB45 but positive results for CD34, Factor Ⅷ, Bcl-2, and STAT6; therefore, the patient was further diagnosed with liver SFT. Although liver SFT is rare, it was considered a differential diagnosis when multiple bloody liver tumors were detected. In addition, since there were reports of recurrence, careful follow-up in future, was deemed necessary.
要旨
孤立性線維性腫瘍(solitary fibrous tumor: SFT)の多くは胸腔内に発生し,肝臓原発のSFTの報告は非常にまれである。今回われわれは,肝臓原発SFTの1例を経験したので文献的考察を加えて報告する。症例は70歳,男性。前医で肝腫瘍を指摘され,精査加療目的に当科紹介となった。造影CTで肝S2/3に3.5 cm大の囊胞と,囊胞内に早期濃染を伴う3.2 cm大の腫瘍を認め,肝囊胞性腺癌の診断で腹腔鏡下肝外側区域切除術を行った。肉眼的には白色の境界明瞭な腫瘍であった。病理組織学的検査では類円形または短紡錘形細胞で,核クロマチンの増量した腫瘍細胞が膠原線維や血管腔様構造の介在を伴って増殖していた。免疫染色でCAM5.2,HepPar1,CD31,CD99,SMA,HMB45が陰性,CD34,Factor Ⅷ,Bcl-2,STAT6が陽性であったことから,肝臓原発SFTと診断した。肝臓原発SFTはまれな腫瘍であるが,多血性肝腫瘍を認めた際には鑑別疾患として考慮すべきと思われた。また,再発の報告もあることから今後も慎重な経過観察が必要と考えられた。