臨床的に肝原発が示唆された神経内分泌癌の一例
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症例は80歳代男性.左外耳道癌(扁平上皮癌)の精査目的で施行された陽電子放射断層撮影･コンピュータ断層撮影にて肝腫瘍を指摘され,精査加療目的で当科に紹介となった.慢性肝障害を伴わない径20mm大の単発性多血性肝腫瘍であり,血液検査及び画像検査所見からは診断に至らなかったため,経皮的肝腫瘍生検が施行された.免疫組織化学的にChromogranin A･Synaptophysin･CD56はいずれも陽性で,Ki-67 indexが70%であったため,神経内分泌癌(小細胞癌)と確定診断された.同病変に対して肝動脈化学塞栓療法(transcatheter arterial chemoembolization;TACE)が施行されたが,その4ヵ月後に超音波内視鏡下吸引穿刺生検にて膵頭部周囲リンパ節転移と診断され,その後は対症療法で経過観察された.TACE後14ヵ月で死亡し,剖検を行ったものの原発巣は同定し得ず,臨床経過より肝原発神経内分泌癌の可能性が高いと考えられた.A hepatic tumor was incidentally detected in an 80-year-old man who was undergoing examination for suspected squamous cell carcinoma of the left external auditory canal with positron emission tomography-computed tomography. Subsequently, the patient was referred to our department for further examination and treatment. The identified hepatic tumor was a 20-mm wide, hypervascular, solitary mass, and no associated chronic liver disorders were observed. Blood tests and imaging studies could not yield an appropriate diagnosis, and therefore, a percutaneous hepatic tumor biopsy was performed. On immunohistochemical staining, positive results were obtained for chromogranin A, synaptophysin, and cluster of differenti-ation 56(CD56),whereas the Ki-67 index was 70%, leading to a definite diagnosis of neuroendocrine carcinoma(small cell carcinoma).Thus, the patient underwent transcatheter arterial chemoembolization(TACE);however, after 4 months, endoscopic ultrasoundfine needle aspiration biopsy confirmed metastasis to the lymph nodes on the anterior surface of the pancreatic head. The patient underwent symptomatic treatment and was kept under observation;however, he died 14 months after TACE. The primary lesion could not be determined even during autopsy. From the clinical course, we believe that it was highly likely that the patient had a primary hepatic neuroendocrine carcinoma.
- 山口大学医学会の論文
- 2014-02-01
山口大学医学会 | 論文
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