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題名 | Sarcomatous Hepatocellular Carcinoma=肝癌合併肉瘤組織變化 |
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作 者 | 李偉誠; 蔡家麒; 陳冬英; 施焄鏻; 王鴻源; 施壽全; 章振旺; | 書刊名 | 臺灣癌症醫學雜誌 |
卷期 | 2:3 2015.09[民104.09] |
頁次 | 頁255-260 |
分類號 | 416.246 |
關鍵詞 | 肝細胞癌c肉瘤狀變化; Hepatocellular c sarcomatosis; |
語文 | 英文(English) |
中文摘要 | 我們報告一個臨床上較為罕見的病例,一個65歲男性有慢性B型肝炎但卻沒有規則追蹤,因為食慾不振且體重減輕去門診求診時意外發現一10公分大的肝臟腫瘤。電腦斷層並沒有明顯的動脈相顯影及非動脈性不顯影等典型肝癌的特徵。AFP有升高所以臨床上還是認為疑似肝癌。經開刀切除後病理證實為一種具有肉瘤變化的肝癌-Hepatoma with sarcomatous change。此病患在開完刀三個月後腫瘤就復發,且多處轉移至腹腔及腦部,雖然經積極治療包括標靶藥物Nexavar及電療,病患依舊於手術後6個月死亡。討論部分提到,這種肝癌據過去統計占所有肝癌的5-14%,預後極差。相比一般的肝癌,有肉瘤變化的肝癌也有較高的肝外轉移率及肝門靜脈侵犯的機率、較低的2年存活率及肝移植機率。遺憾的是,此種患者在用傳統診斷肝癌的工具如超音波,AFP、電腦斷層甚至核磁共振上都沒有太專一性的表現可以與一般的肝癌鑑別。只有一篇文章由Ijichi在2012年提到用18F-fluorodeoxyglucose positron emission tomography(FDG-PET)可以在術前鑑別肝癌是否有肉瘤變化。但這部分還需要更多研究去證實。 |
英文摘要 | Sarcomatous hepatocellular carcinoma (HCC) is a rare subtype of hepatoma, along with worse prognosis than ordinary HCC. The risk of this subtype is still unknown, but some believed it has to be related to post anti-cancer therapy. We reported a case of sarcomatous HCC and the patient did not receive any anti-cancer therapy before. He came to our outpatient department due to symptoms of generalized malaise and poor appetite. One 10 cm in sized tumor was detected by ultrasound. He received surgical resection of the tumor but the tumor recurred after 3 months, with multiple metastases to peritoneum and brain. However, even under aggressive treatment, patient still expired in 6 months after operation. We reviewed several reports of this subtype of HCC. It was known that sarcomatous HCC is hard to be distinguished with ordinary HCC before surgery. There is no evidence that adjuvant therapy including chemotherapy, radiotherapy and target therapy may improve the survival rate. It would usually be diagnosed as atypical HCC and treated as ordinary HCC, however, the prognosis is much worse; this sarcomatosis type HCC should be seriously considered. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。