A Case of Nasal Metastasis from Hepatocellular Carcinoma
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概要
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Metastatic carcinoma to the nose and paranasal sinuses is relatively rare. In Japan, only 21 cases of metastatic hepatocellular carcinoma (HCC) to the nose and paranasal sinuses were reported. We report the clinical manifestation of a rare case of HCC with metastasis to the left nasal cavity.A 67-year-old man treated for HCC for 6 years had undergone the right lung upper lobectomy for metastatic HCC to the right lung 5 years earlier. His chief complaint was epistaxis. Anterior rhinoscopy showed a tumor in the left nasal cavity. CT showed a mass 2cm in diameter in the left nasal cavity, which did not extend to paranasal sinuses. The serum PIVKA-II was 4, 340AU/ml, AFP 10ng/ml, CEA 3.0ng/ml and CA19-949ng/ml. We biopsied the nasal tumor, which revealed metastatic HCC. Because of multiple lung metastasis, we didn't attempt radical surgery for the nasal tumor. Due to severe postbiopsy hemorrhage, anemia developed. To improve the patient's general condition, we embolized the artery feeding the tumor, resected the nasal tumor, and undertook reconstruction with a forehead flap. Postoperative epistaxis did not occur. The man's respiratory function was decreased by multiple lung metastasis and MRSA infection, and he died of sepsis and DIC after two weeks.In conclusion, the possibility of metastatic tumor should be considered in differential head and neck diagnosis. If metastatic HCC is suspected, biopsy should be avoided to prevent severe postbiopsy hemorrhage. Instead of biopsy, fine-needle aspiration is recommended. Chemotherapy and radiotherapy were effective in severe postbiopsy hemorrhage. If we had conducted chemotherapy or radiotherapy instead of tumor resection, the prognosis may have been better.
- 日本鼻科学会の論文
日本鼻科学会 | 論文
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