1例Vp4肝细胞癌伴肿瘤血栓形成延伸至脾/门静脉汇合处，急诊

StephenW

1例Vp4肝细胞癌伴肿瘤血栓形成延伸至脾/门静脉汇合处，急诊肝切除术及术后乐伐替尼辅助治疗预后良好
加藤博之 1 , 浅野由纪夫 2 , 伊藤雅弘 2 , 荒川聪 2 , 志村雅宏 2 , 小池大辅 2 , 越地隆之 2 , 安冈博信 2 , 河合时 2 , 东口隆彦 2 , 谷弘树 2 , 国村佳树 2 , 近藤由香2、永田英寿 2、佐藤春信 2、堀口明彦 2
隶属关系
隶属关系

    1
    日本爱知县名古屋市 3-6-10 Otobashi Nakagawa Ward Nagoya, Fujita Health University School of Medicine, Bantane Hospital, 454-8509, Japan [email protected]。
    2
    日本爱知县名古屋市 3-6-10 Otobashi Nakagawa Ward Nagoya, Fujita Health University School of Medicine, Bantane Hospital, 454-8509, Japan

    PMID：36057621 DOI：10.1186/s12957-022-02740-w

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抽象的

在本报告中，我们描述了一例高度晚期肝细胞癌，其肿瘤血栓形成延伸到胰腺的主要门静脉，在右肝切除并取栓后，用乐伐替尼辅助治疗成功。一名 70 岁的女性因肝胆酶升高而被转诊至诊所。患者在我院乙肝病毒抗原阳性。肿瘤标志物高度升高，甲胎蛋白（14.5 U/mL）和维生素K缺乏诱导的蛋白（PIVKAII）（1545 ng/mL）提示肝细胞癌。动态腹部计算机断层扫描显示早期增强的肿瘤大小约为 6 cm，门静脉肿瘤血栓形成充满主要的门静脉，但未延伸到脾或肠系膜上静脉 (SMV)。 CT 后 1 周磁共振成像显示，门静脉肿瘤血栓形成已扩展到脾静脉与 SMV 的汇合处，表明肿瘤快速生长。因此，我们进行了紧急右肝切除术和肿瘤血栓切除术。术后，我们用乐伐替尼治疗患者进行肿瘤缩小手术。幸运的是，患者术后2年还活着，没有复发。该病例报告表明，通过包括切除和乐伐替尼术后治疗在内的多学科治疗可能会取得良好的结果。

关键词：乐伐替尼；肿瘤血栓形成；副总裁4。

© 2022。作者。

StephenW

A case of Vp4 hepatocellular carcinoma with tumor thrombosis extending into the confluence of the splenic/portal vein achieved a good prognosis with emergent hepatectomy and postoperative adjuvant therapy with lenvatinib
Hiroyuki Kato  1 , Yukio Asano  2 , Masahiro Ito  2 , Satoshi Arakawa  2 , Masahiro Shimura  2 , Daisuke Koike  2 , Takayuki Ochi  2 , Hironobu Yasuoka  2 , Toki Kawai  2 , Takahiko Higashiguchi  2 , Hiroki Tani  2 , Yoshiki Kunimura  2 , Yuka Kondo  2 , Hidetoshi Nagata  2 , Harunobu Sato  2 , Akihiko Horiguchi  2
Affiliations
Affiliations

    1
    Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward Nagoya, Nagoya, Aichi, 454-8509, Japan. [email protected].
    2
    Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward Nagoya, Nagoya, Aichi, 454-8509, Japan.

    PMID: 36057621 DOI: 10.1186/s12957-022-02740-w

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Abstract

In this report, we describe a case of highly advanced hepatocellular carcinoma with tumor thrombosis extending into the main portal vein of the pancreas that was successfully treated with adjuvant lenvatinib after right hepatic resection with thrombectomy. A 70-year-old woman was referred from the clinic because of elevated hepatobiliary enzymes. The patient was positive for the hepatitis B virus antigen at our hospital. The tumor markers were highly elevated with alpha-fetoprotein (14.5 U/mL) and protein induced by vitamin K absence (PIVKAII) (1545 ng/mL), suggesting hepatocellular carcinoma. Dynamic abdominal computed tomography showed an early enhanced tumor approximately 6 cm in size and portal vein tumor thrombosis filling the main portal vein, but not extending into the splenic or superior mesenteric vein (SMV). On magnetic resonance imaging 1 week after CT, portal vein tumor thrombosis had extended to the confluence of the splenic vein with the SMV, indicating rapid tumor growth. Thus, we performed emergent right hepatectomy with tumor thrombectomy. Postoperatively, we treated the patient with lenvatinib for a tumor reduction surgery. Fortunately, the patient was alive 2 years postoperatively without recurrence. This case report suggests that a favorable outcome may be achieved with multidisciplinary treatment including resection and postoperative treatment with lenvatinib.

Keywords: Lenvatinib; Tumor thrombosis; Vp4.

© 2022. The Author(s).

StephenW

https://wjso.biomedcentral.com/t ... /s12957-022-02740-w