A case of pedunculated hepatoma suspected of adrenal tumor

We herein report a case of pedunculated hepatoma which was preoperatively diagnosed as nonfunctioning adrenal tumor. A 51-year-old man was admitted for further examination of right hypochondrial pain. CT scan showed a right suprarenal mass. Tumor vessels were visualized on selective right renal arteriography and right inferior phrenic arteriography. Adrenal function was normal. Preoperative diagnosis was nonfunctioning right adrenal tumor. On operation, we found a right suprarenal tumor which was in continuity with the inferior part of the liver. Pathological diagnosis of the biopsy specimen was hepatocellular carcinoma (Edmondson's grade 3). Difficulty of preoperative diagnosis of pedunculated hepatoma is discussed.     

A case of pedunculated hepatoma suspected of adrenal tumor]

A case of pedunculated hepatoma which was preoperatively diagnosed as non-functioning adrenal tumor is reported. A 48-year-old man presented to our hospital for further examination of remittent fever and leg edema. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging showed a right suprarenal mass, its continuity of liver was uncertain. Tumor vessels were visualized on selective right adrenal arteriography and right adrenal function and serum alpha-fetoprotein were normal. Preoperative diagnosis was non-functioning right adrenal tumor. On operation, the dissection between the tumor and the inferior part of liver was easy. Pathological diagnosis was hepatocellular carcinoma with sarcomatous change. Difficulty of preoperative diagnosis of pedunculated hepatoma is discussed.     

Pedunculated hepatocellular carcinoma suspected of right adrenal tumor: a case report]

We report a rare case of extrahepatic growing hepatocellular carcinoma which was clinically diagnosed as right adrenal tumor. A 61-year-old woman was admitted for further examination of right flank pain and hypertension. Abdominal computed tomographic scan and echogram revealed a suprarenal mass. Hypercatecholaminemia was suspected from urinary analysis. Preoperative diagnosis was right adrenal tumor; suspected pheochromocytoma. On operation, we found the tumor was pedunculated from right lobe of liver and compressing normal right adrenal gland. Its clinical diagnosis was hepatocellular carcinoma. Ten months after operation she is still alive. We discuss the difficulty of differential diagnosis between extrahepatic growing hepatocellular carcinoma and adrenal tumor.     

Metastatic adrenal carcinoma suspected as a primary tumor: a case report

A 62-year-old man was admitted with chief complaints of fever and general fatigue. Enhanced computed tomography revealed a tumor (5 cm in diameter) in the right suprarenal space, and the right renoportal lymph nodes were swollen. An abdominal TI-weighted MR image showed a low-intensity tumor measuring 4.5 x 5.5 x 6.0 cm. Chest computed tomography revealed two tumors. One was 1.5 cm, on the hilum of left lung, the other was 1 cm in the S6 lung field near the pleura. These findings strongly indicated primary adrenal carcinoma and lung metastasis. Right adrenalectomy was performed. Histological examination of this tumor revealed diffuse tumor cells with irregular nuclei, and it was diagnosed as poorly differentiated adenocarcinoma. There was no possibility of primary adrenal carcinoma. The primary site of the tumor was suspected to be the left lung.     

巨大外生型肝癌的外科治疗

目的 探讨巨大外生型肝癌的特征、外科治疗及疗效。方法 总结分析了我院1998年1月至2002年1月间收治并手术治疗的巨大外生型肝癌8例。结果 所有病人均获手术治疗切除，无1例手术死亡，肿瘤最大直径为12430cm，平均18．12cm，瘤体均有完整包膜。术后随访12460个月，期间2例因肿瘤复发死亡，其余存活。结论 巨大外生型肝癌治疗方法应首选手术切除，术后预后相对较好。     

A case of hepatocellular carcinoma with tuberculoma within tumor tissue

We made a diagnosis of hepatocellular carcinoma and performed partial resection of the liver in a 72 year-old woman. Granulomas were observed within hepatocellular carcinoma in the surgical specimen. Microscopic findings demonstrated the granulomas particularly within the tumor, and showed that they were composed of epithelioid cells with caseous necrosis. These tuberculomas compressed the tumor cells, and many lymphocytes had infiltrated the tumor around the tuberculomas. The cancer stage of the patient was early and her prognosis is good.     

Surgical therapy in two patients with pedunculated hepatocellular carcinoma

Hepatocellular carcinoma (HCC) occurring as an appendage from the main hepatic parenchyma is a rare entity, of which two cases are herein described. Because proper surgical management of this tumor (pedunculated HCC) is unclear, the world's literature was reviewed to determine optimal therapy. Thirty-four cases were documented, including the two cases reported herein. Diagnosis was usually obscure, despite modern invasive and noninvasive methods, and laparotomy or autopsy were required for specific identification of tumor type. Sixteen resections were reported among 18 explorations. One patient had transarterial embolization. Fifteen received medical therapy only. Surgically treated patients usually died of metastatic disease, whereas most medically treated patients died of gastrointestinal or tumor hemorrhage. Pedunculated HCC may be more amenable to curative resection than ordinary HCC due to its unique localization and growth pattern.     

外生性肝癌17例诊治分析

目的探讨外生性肝癌的临床诊断和治疗方法。方法回顾性分析17例外生性肝癌的临床资料。结果本组男15例，女2例。瘤体平均大小为8cm×6．6cm×5．5cm；均有完整包膜；中高分化肝细胞癌15例；主要检查方法为B超和CT；治疗方式为手术切除，辅以术中术后化疗。结论外生性肝癌单一依靠B超或CT难以明确术前诊断，手术切除是外生性肝癌的主要治疗方法。提高早期确诊率和切除率才是提高生存率延长生存时间的关键。     

A case of adrenal cortical carcinoma

We report a case of left adrenocortical carcinoma in a 23-year-old man. His chief complaints were spike fever attack and general malaise. Imaging examination revealed a heterogeneously enhanced mass at the site of the left adrenal gland. Non-functional adrenocortical carcinoma was suspected from hormonal studies. The mass was removed together with the left kidney because of severe adhesion to the renal pedicle. The histopathological findings showed adrenocortical carcinoma (pT3N0M0). Three months after surgery, local recurrence appeared and the tumor grew larger rapidly. Spike fever attack reappeared. No distant metastasis was detected. Two courses of systemic chemotherapy with o, p'-DDD, VP-16, adriamycin and cisplatinum were performed. Computed tomography after the chemotherapy showed progression. Although o, p'-DDD was administered continuously, the patient died of cancerous cachexia 8 months after the surgery. Autopsy could not be done.     

巨大原发性外生型肝癌的临床特点及治疗

目的探讨巨大原发性外生型肝癌的临床特点、诊断和治疗方法。方法回顾性分析我院2001年1月～2007年2月收治的巨大原发性外生型肝癌13例的临床资料。结果全部病例均行手术切除。术后无肝功能衰竭、胆漏、大出血等并发症发生,无围手术期死亡病例。结论巨大原发性外生型肝癌手术切除率高,预后较好。     

A resected case of collision tumor of hepatocellular carcinoma and primary liver rhabdomyosarcoma

Primary liver sarcoma is rare and especially its coexistence with hepatocellular carcinoma is extremely rare. We have collected eight cases of their coexistence in the literatures. The patient was a 62-year-old male complaining of right hypochondralgia and general malaise for about one month. CT scanning revealed the liver tumor and right hepatic lobectomy was performed. The tumor was sized in 14 by 9 by 9 cm and composed of hepatocellular carcinoma and rhabdomyosarcoma, which were were collided. Apparent striations in the rhabdomyosarcoma cells was observed under light-microscope. Alphafetoprotein, of which serum level was extraordinarily high, was detected only in hepatocellular carcinoma by special stains. He discharged one month after operation. He was readmitted due to recurrence and received trans-arterial embolisation therapy and systemic chemotherapy. Though transient effect was obtained. He died forty-five days after operation. Autopsy revealed that recurrent liver tumors consisted of only hepatocellular carcinoma and that no other tumorous lesion was found in the other parts of the body. Rhabdomyosarcoma was proved to be primary tumor the liver.     

外生型肝癌的外科治疗及远期预后影响因素

[摘 要] 目的 探讨外生型肝癌（PHCC）的临床病理特点、外科治疗方式、手术远期预后及其影响因素。方法 采用回顾性队列研究的方法,收集东方肝胆外科医院肝外五科于2011年1月至2017年12月期间行根治性肝癌切除术的65例PHCC患者的临床资料及随访数据,按照肿瘤所在位置分为两类：膈面生长型PHCC组（27例）和脏面生长型PHCC组（38例）。对两组患者的基线特征、肿瘤病理特征、围手术期结果和远期预后进行对比研究。结果 与膈面生长型PHCC组相比,脏面生长型PHCC组具有更大的肿瘤直径（9.8 vs6.2 cm,P=0.048）,更可能合并破裂出血（31.6% vs 11.1%, P=0.046）和伴有微血管侵犯（71.1% vs 44.4%,P=0.031）。两组患者均未出现围手术期死亡,膈面和脏面生长型PHCC组术后并发症发生率分别为25.9%和31.6%,不存在统计学差异（P > 0.05）。在远期预后方面,该65例患者的1、3、5年总生存率（OS）和无复发生存率（RFS）分别为82.6%、51.5%、41.6%和78.3%、60.3%、35.1%。膈面生长型PHCC组的1、3、5年OS和RFS分别为88.1%、64.0%、47.4%和85.0%、55.0%、45.9%,显著高于脏面生长型PHCC组的78.7%、42.7%、37.4%和73.4%、33.8%、30.1%,两组之间的差异具有统计学意义（P=0.031,P=0.042）。Cox多因素回归分析证实,合并肝硬化、Child-Pugh B级、脏面生长型PHCC、合并破裂出血、合并大血管侵犯是影响PHCC患者OS的独立危险因素;此外,脏面生长型PHCC、合并破裂出血、合并微血管侵犯、合并大血管侵犯是影响PHCC患者RFS的独立危险因素。结论 PHCC是一类特殊类型的HCC,肿瘤体积较大,手术切除是主要根治性手段,术后5年生存率可达到40%以上;膈面生长型PHCC的远期预后优于脏面生长型PHCC,肿瘤生长部位是影响PHCC患者OS和RFS的独立危险因素。     

椎旁转移性肝细胞癌1例

1病例资料患者,男,59岁。因左下肢放射性疼痛4个月,加重2个月入院。一般情况好,神志清。皮肤及黏膜无黄染,肝脏未触及,无明显叩击痛。L2~4左侧椎旁可触及12 cm×12 cm大小质韧肿物,局部压痛,活动度差,周围边界欠清。左大腿前外侧感觉减退,直腿抬高试验及加强试验均为阴性。双下肢肌力正常。腰椎MR I及CT均示:左椎旁神经源性肿瘤。肝功及凝血酶原时间均正常。初步诊断:椎旁肿瘤,性质待诊。行肿瘤切除术,术中见肿瘤边界不清,累及左侧横突及椎间孔,腰大肌及肾脏向前移位,出血多。术后标本行病理检查,结果为转移性肝细胞癌。血甲胎球蛋白(AF…     

Management of adrenal metastasis from hepatocellular carcinoma

Purpose: Although the adrenal gland is a common site of extrahepatic metastasis from hepatocellular carcinoma (HCC), there are no definitive guidelines for the treatment of adrenal metastasis. This study examines the effectiveness of various treatments for this disease. Methods: We retrospectively analyzed 20 patients treated for adrenal metastasis of HCC by adrenalectomy (n = 13), transarterial chemoembolization (TACE), or percutaneous ethanol injection therapy (PEIT) (n = 7). Results: There were no significant differences in cumulative survival rates between patients given adrenalectomy and those given TACE or PEIT, either after completing treatment for primary HCC or after the first treatment for adrenal metastasis. Six of seven patients with tumor thrombi in the inferior vena cava (IVC) from adrenal metastasis underwent adrenalectomy combined with intracaval thrombectomy, five of whom survived for more than 1 year after surgery, and two of whom are still alive without any recurrence more than 3 years after surgery. PEIT showed good results for small adrenal metastasis. Conclusion: These findings suggest that therapeutic modalities should be chosen according to the clinical features of each individual, including the size of the metastatic tumor, whether there is invasion into the IVC, the function of the remaining liver, and the existence of intra- and/or nonadrenal extrahepatic lesions. Furthermore, intracaval tumor thrombectomy could be indicated for patients with IVC thrombus if they are suitable candidates for surgery. Received: July 9, 2001 / Accepted: July 2, 2002 Reprint requests to: Y. Shimahara     

A case of urachal xanthogranuloma suspected to be a urachal tumor

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.