肝膿瘍を疑った胃癌肝転移の1例

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A 56-year-old man was admitted to the emergency department of our hospital because of fever and general malaise. Abdominal ultrasonography and computed tomography revealed a cystic mass, measuring about 7 cm in diameter, with a capsule-like area. The mass was situated mainly in the right hepatic lobe. Percutaneous transhepatic abscess drainage (PTAD) was performed because of a suspected hepatic abscess. The effect of drainage was inadequate. Upper gastrointestinal endoscopy was performed to determine the underlying cause. An irregular-elevated lesion was found in the gastric cardia. Liver metastasis was strongly suspected. Biopsy of the hepatic mass was performed at the time of total gastrectomy. Histopathological examination showed a poorly differentiated adenocarcinoma invading the middle layer of the submucosa (Tl, sm2), with moderate venous invasion (v2), minimal lymphatic invasion (ly1), and metastasis to the Group 1 lymph nodes (n1) of the stomach. The liver biopsy disclosed metastases from gastric cancer. Subsequently, a right lobectomy was performed. Liver masses with a cystic structure may be difficult to distinguish from abscesses on imaging studies. In patients with a hepatic mass who present with fever and inflammatory findings, malignant tumors should be included in the differential diagnosis.
東京女子医科大学の論文