A case of peritoneal dissemination of hepatocellular carcinoma after repeated medical therapies and partial hepatectomy

症例は57歳の男性.2001年3月より肝｢S2｣,｢S6｣の肝細胞癌に対して2009年までに数回のradio frequency ablation(以下,RFA)とtranscatheter arterial chemoembolization(以下,TACE)治療歴あり.2010年1月肝｢S6｣肝細胞癌に対し肝｢S6｣部分切除を施行した.2010年12月右下腹部腫瘤を主訴に受診,腹部CTにて回盲部に直径10cm大の腫瘤を認めた.PIVKA-IIの上昇を伴っており腹腔内転移を疑い虫垂切除および腫瘤摘出術を施行した.腫瘍は虫垂後面に癒着して発育していたが,虫垂および盲腸壁には異常所見は認められず,病理組織学的にも後腹膜への播種性転移と確定診断されたが,初回切除標本と比べて細胞の分化度は明らかに悪化していた.その4ヵ月後に下痢・腹痛が出現し,CTで下行結腸の外側に径7.5cm大の腫瘍性病変を認めた.その他にも腹腔内に造影剤にて早期濃染する結節が散在しており,腹腔内全体への腹膜播種の増悪と診断した.今回,われわれは繰り返す内科的治療と肝部分切除後に細胞分化度が悪化した腹膜播種を生じたまれな肝細胞癌の1例を経験したので文献的考察を加えて報告する.

A 57-year-old man had been followed up for hepatocellular carcinoma in S2 and S6 since May 2001. He had received several sessions of radiofrequency ablation(RFA)and transcatheter arterial chemoembolization(TACE)till 2009. He underwent S6 partial hepatectomy for hepatocellular carcinoma in January 2010. When seen for right lower abdominal pain in December 2010, abdominal CT revealed a tumor 10 cm in diameter in the ileocecal region. We suspected abdominal recurrence of hepatocellular carcinoma because of a rise in the PIVKA-II level, and performed extirpation of the tumor with appendectomy. Although macroscopically the tumor adhered to the posterior wall of the ileocecal region, histopathologically the wall of the appendix was intact. Six months later there was a subsequent episode of ileus, and abdominal CT revealed a new tumor measuring 7.5 cm on the lateral side of the descending colon. As enhanced CT in the arterial early phase also revealed several nodules, we diagnosed extensive dissemination of hepatocellular carcinoma. We report this rare case of peritoneal dissemination of hepatocellular carcinoma after repeated RFA/TACE treatment and partial hepatectomy along with a review of the literature.

肝細胞癌

腹膜播種