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頁籤選單縮合
題名 | Hepatocellular Carcinoma Presenting with Acquired Porphyria: A Case Report and Review of the Literature=肝細胞癌併後天性呲喀紫質沈著症:一例報告及文獻回顧 |
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作者 | 黃武雄; 廖麗瑛; 王朝欣; 陳寶輝; | 書刊名 | 長庚醫學 |
卷期 | 22:1 1999.03[民88.03] |
頁次 | 頁111-116 |
分類號 | 415.5362 |
關鍵詞 | 胎兒蛋白; 肝癌; 副癌症候群; 呲喀紫質沈著症; Alpha-fetoprotein; AFP; Hepatocellular carcinoma; HCC; Paraneoplastic syndrome; Porphyria cutanea tarda; PCT; |
語文 | 英文(English) |
中文摘要 | 原發性肝癌引起的副癌症候群,較常見的是以低血糖,紅血球過多症,高血鈣症 及高膽固醇血症來表現,以呲喀紫質沈著症表現者甚為少見。 根據文獻的記載, 目前僅有 12 篇報告。 大多發生於老年人合併巨大肝癌,皮膚特徵則多屬早期皮膚呲喀紫質沈著症的 表現 -- 包括皮膚色素沈著,脆性增加及光照處出現皮下水皰。病人血清、尿及糞便中的紫 質素則視臨床狀況之不同而有個別或全部的上升。 本文報告一位73歲女性病人因在肝癌家族篩檢中發現一肝腫瘤,而住進臺北市立仁愛醫院。 病人無紫質沈著症家族史,但有臉部色素沈著現象達 2 個月之久。 肝臟切片證實為第Ⅰ度 之肝細胞癌。 她的血清胎兒蛋白質為 25.2 ng ╱ ml, 而鋅原紫質素( zinc protoporphyrin )則為 106 μ mol ╱ mol H。之後,她接受肝癌動脈栓塞治療。10 天後 , 她的血清胎兒蛋白值下降為 18.3 ng ╱ ml,而鋅原紫質素( zinc protoporphyrin ) 則下降為 90 μ mol ╱ mol H。 |
英文摘要 | Hepatocellular carcinoma (HCC) with acquired porphyria is a very rare condition. It is characterized variably by hyperpigmentation, skin fragility and photodistributed subepidermal vesicles. The serum, urine and/or stool porphyrin levels, usually markedly elevated, can change according to the clinical course. We report here a case of hepatocellular carcinoma presenting with a paraneoplastic syndrome of acquired porphyria. A 73-year-old Chinese woman had the characteristic facial pigmentation of cutaneous porphyria and histologically proven hepatocellular carcinoma. Her serum zinc protoporphyrin was elevated and her urine tested positive for coproporphyrin. Her protoporphyrin and alpha-fetoprotein levels dropped after transarterial chemoembolization treatment. Acquired porphyria in hepatocellular carcinoma occurs exclusively in order persons with huge hepatocellular carcinoma and/or cirrhosis. Before diagnosis, it must be carefully differentiated from inherent porphyrias with HCC, and porphyrias induced by drugs or heavy metal intoxication must be ruled out. |
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