Fibrolamellar carcinoma of the liver--a case report.

A 36-year-old woman was admitted to our hospital because of general fatigue. The physical and laboratory findings on admission revealed splenomegaly, pancytopenia, hypocoagulopathy, liver hypofunction with a hepaplastin test of 55% and ICG Rmax of 0.6 mg/kg/min. Diagnostic imaging showed a hypoechoic mass 1.5 in diameter a low density area on the CT scan and a faint tumor stain on the AAG in the posterior inferior area of the liver. On a diagnosis of hepatocellular carcinoma with liver cirrhosis and hypersplenism, partial hepatectomy and splenectomy were performed. The resected hepatic specimen revealed a small liver cancer of 1.9 x 1.5 x 1.3 cm with liver cirrhosis. The specimen consisted of a firm rubbery mass. Macroscopically, the tumor appeared oval and was lobulated with a thin capsule. A fibrous scar was observed in the central area. Microscopically, malignant hepatocytes showed various shapes, ranging from polygonal to spindle form, with eosinophilic granular cytoplasm and were surrounded by abundant fibrous stroma. Orcein stain, revealed that these malignant hepatocytes contained many black granules of copper-binding protein. Immunoperoxidase staining for alpha 1-antitrypsin was also positive in the malignant hepatocytes. However, within this lamellar fibrous regions, there were many cords of tumor cells in which nucleoli were absent and abortive biliary differentiation was suggested. Consequently this tumor was diagnosed as an atypical fibrolamellar hepatocellular carcinoma. We think that this case is the 3rd case reported in Japan and the 2nd case in a Japanese person.     

Malignant fibrous histiocytoma of the liver--a case report

A case of primary malignant fibrous histiocytoma of the liver studied by light and electron microscopy and confirmed at autopsy is presented. Malignant fibrous histiocytoma, the most common adult soft tissue sarcoma, has been reported in most organs but to date has not been described as a primary liver tumor.     

A case of primary mucoepidermoid carcinoma arising from the common bile duct

Mucoepidermoid carcinoma of the bile duct is an extremely rare tumor. Seventeen cases originating from intrahepatic bile duct and 2 cases from common hepatic duct have been reported in the English literature. Mucoepidermoid carcinoma arising from the common bile duct has not been previously reported. A 68 year-old man was admitted due to obstructive jaundice. Computed tomography showed a malignant tumor of the common bile duct located in the intrapancreatic segment. Filling defects of the distal common bile duct was seen on endoscopic retrograde cholangiogram. Under the impression of bile duct cancer, pylorus-preserving pancreatoduodenectomy was performed. Histologic diagnosis of the resected specimen was mucoepidermoid carcinoma of the common bile duct. After surgery, the patient received concurrent chemoradiotherapy, and planned to receive additional chemotherapy. We herein report on a first case of primary mucoepidermoid carcinoma of the common bile duct, and review the literature.     

原发性肺黏液表皮样癌1例报告并文献复习

目的 提高对原发性肺黏液表皮样癌的认识.方法 结合1例原发性黏液表皮样癌患者的临床资料,搜集13篇国内文献的199例患者的临床资料以及复习国内外相关文献,分析、归纳该病的临床表现、影像学特点、病理学特征、诊断及鉴别诊断、治疗及预后.结果 原发性肺黏液表皮样癌的临床症状为咳嗽、咳痰、胸闷、胸痛,但症状缺乏特异性.胸片常显示出肺不张或肺炎,CT主要表现为光滑分叶状或息肉状肿块伴远端支气管黏液嵌塞和肺不张.病理学检查主要特征是可见不同比例的黏液分泌细胞、鳞状表皮样细胞以及中间型细胞组成,未见角化.治疗首选手术,放、化疗治疗效果目前没有得到肯定.预后相较于传统的非小细胞肺癌更好.结论 原发性肺黏液表皮样癌罕见,容易误诊,应充分认识该病的有关特点,提高疗效,改善预后.     

Malignant fibrous histiocytoma of the liver--a case report.

A case of surgically confirmed primary malignant fibrous histiocytoma of the liver is presented. A 35-year-old man was admitted to hospital with an epigastric mass. No abnormal laboratory findings, including tumor markers, were detected. Ultrasound and computed tomography showed the main tumor in the left lateral segment and a daughter nodule in the posterior segment of the liver. Arteriography demonstrated a slightly hypervascular mass in the left lateral segment. Histological examination of the resected tumor showed bundles of spindle cells with a focal storiform pattern, which were intermingled with bizarre giant cells, therefore a diagnosis of malignant fibrous histiocytoma was made.     

肝肉瘤样癌误诊为肝细胞癌1例报告

肉瘤样癌是指形态学类似梭形细胞肉瘤但实际上为癌的一类较少见恶性肿瘤的总称,可以发生在全身多个器官,但以上呼吸道、肺、乳腺和肾常见^（[1]）。肝肉瘤样癌（sarcomatoid hepatocellular carcinoma,SHC）是发生于肝脏的一种少见的恶性肿瘤,恶性程度高,预后较差,1年生存率几乎为0^（[2]）。1病例资料患者男性,54岁,因＂发现肝占位2年,反复发热1个月＂     

Synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma: A case report and review of the literature

Rationale:Presence of synchronous double hepatocelluar carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (sdpHCC-ICC) located separately within a single liver is extremely rare. The purpose of this study is to investigate the clinical, imaging, pathological characteristics, and prognosis of patients with sdpHCC-ICC, in order to enhance our understanding of the disease and improve diagnostic and therapeutic effect.Patient concerns:A 49-year-old, female with the diagnosis of hepatitis B virus with obvious liver cirrhosis, was admitted to our hospital. On admission, the levels of α-fetoprotein and carbohydrate antigen 19-9 were found to be elevated. Abdominal ultrasonography and enhanced computed tomography revealed 2 solid masses located in segments (S) 4 and 6 of the liver, with malignant behaviors.Diagnoses:In the light of above investigations, preoperative diagnosis of multiple primary hepatocellular carcinomas was made.Intervention:Hepatic resection of both segments was done. The resected specimens revealed the presence of well-defined tumors in segments 4 and 6 measuring 5.0 cm and 2.5 cm respectively.Outcomes:Histopathological examination confirmed the tumor of the 4th segment to be moderately and poorly differentiated ICC, and the tumor of the 6th segment to be poorly differentiated HCC. Immunohistochemically, the ICC in S4 was positive for CK19 and negative for Heppar-1, whereas the HCC in S6 was positive for Heppar-1 and negative for CK19. Unfortunately, metastasis to multiple organs and lymph nodes were observed 3 months later. The patient died of liver failure 16 months after surgery.Lessons:The clinical characteristics of sdpHCC-ICC are usually atypical and nonspecific making its preoperative diagnosis quite difficult. Hepatitis B virus and hepatitis C virus infection were both the independent risk factor for the development of sdpHCC-ICC. In patients with chronic liver disease, careful observation with imaging is of utmost necessity. Tumor markers may also play a valuable role in the diagnosis. The definite diagnosis depends on pathological examination. Hepatic resection is considered the most effective mode of treatment. The prognosis of synchronous occurrence of double hepatic cancers is worse than either HCC or ICC, and the origin of the disease needs further study.     

Fibrolamellar hepatocellular carcinoma: report of a case

We report a case of fibrolamellar hepatocellular carcinoma, which occurred in a 58-year-old man with normal liver function. Preoperative ultrasonography, computed tomography and magnetic resonance imaging depicted a large tumor in the left lateral segment, which was compatible with the typical radiological features of fibrolamellar hepatocellular carcinoma. He underwent left lobectomy and no lymphadenopathy or distant metastasis was demonstrated. Macroscopic findings of the resected liver demonstrated a well-defined whitish-yellow tumor with a central scar. Microscopic findings of the tumor showed cords of tumor cells, which were surrounded by abundant collagenous fibrous tissue arranged in a lamellar distribution. He has been doing well for approximately one year since the surgery without any signs of recurrence. In addition, we discuss the clinicopathological features of fibrolamellar hepatocellular carcinoma based on a review of 22 Japanese patients who have been previously reported.     

A case of primary mucoepidermoid carcinoma of the thyroid: molecular evidence of its origin

Primary mucoepidermoid carcinoma (MEC) of the thyroid is very rare, and its origin has not been fully determined. We report a case of MEC, the origin of which was demonstrated by thyroid specific genes expressed in a metastatic lymph node. A 52-year-old male presented with chest pain, weight loss and diffuse goitre. Ultrasonography showed the thyroid to be diffusely enlarged with numerous small calcifications. The tumour was found to be infiltrating the thyroid, lung, lymph nodes and first thoracic vertebra. A variant type of papillary thyroid carcinoma was suspected by fine needle aspiration cytology of the thyroid. An open biopsy specimen from an axillary lymph node revealed the tumour to be composed of three distinct cell types: mucin-producing cells, intermediate cells and a small amount of epidermoid cells with scattered psammoma bodies. Immunohistochemical studies showed the tumour cells to be negative for thyroglobulin and calcitonin, but positive for CEA. To examine the primary origin of the tumour, the expression of thyroid specific genes in the lymph node specimen was examined by RT-PCR. TTF-1, TTF-2, Pax-8, Na-I symporter and thyroid peroxidase mRNA were detected. The presence of these thyroid-specific mRNAs indicates that this MEC originated from thyroid follicular epithelium. This is the first molecular evidence of dedifferentiation from thyroid follicular cells to MEC.     

原发性肝癌胸壁皮肤转移1例报告

正肝癌常见的转移途径有血行转移、淋巴转移、种植转移和直接浸润,而以肝内血行转移最早、最为常见。肝癌细胞侵犯肝静脉后即可进入体循环,发生肝外远处转移,以肺转移发生率最高,其次为肾上腺、骨、卵巢等,皮肤转移者较为少见,仅占所有皮肤转移癌的0.2%~2.7%[1]。本文报道1例原发性肝癌胸壁皮肤转移患者。1病例资料患者男性,46岁,因"发现肝占位3月余,腹胀、乏力1个     

Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration： A case report

Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.     

原发性肝癌肝动脉化疗栓塞术后胆管损伤1例报告

<正>1病例资料男性患者,58岁,3年前因右上腹部胀闷不适来医院就诊。CT检查发现肝左叶占位性病变,直径约4 cm,考虑血管瘤,未处理,未定期复查。1年前仍感上腹部不适来医院复诊,CT检查发现肝左叶占位性病变,直径约8 cm,考虑肝癌可能,行腹腔镜左半肝切除+胆囊切除术,术后病理提示肝细胞癌。9个月前行预防性肝动脉化疗栓塞(transcatheter arterial chemoemboli-     

A rare tracheal malignant tumor: mucoepidermoid carcinoma (a case report)

An 18-year-old male preferred to our clinic with hemoptysis, cough, dyspnea and stridor. A wide-based polypoid tumor that was localized at the right wall of the distal trachea was observed over 3 cm from the carina by flexible bronchoscope. Computerized tomography showed an intraluminal soft tissue density mass in the trachea. Though right thoracotomy, a tracheal resection that contains three rings of the trachea with malignant lesion was performed. Pathologic examination reported a tracheal mucoepidermoid carcinoma. The patient is alive without recurrence three years after surgery.     

Donafenib treatment for hepatocellular carcinoma: A case report

Rationale:Hepatocellular carcinoma (HCC) is the most common liver cancer. The efficacy of the present treatment is disappointing, and the prognosis is poor. Donafenib, a novel multikinase inhibitor, is a new deuterated derivative of sorafenib. It can improve overall survival in patients with advanced HCC, with a favorable safety and tolerability profile over sorafenib.Patient concerns:Here, we report the case of a 51-year-old male patient who presented with experienced epigastric discomfort for the prior several days. He had a history of untreated chronic hepatitis B virus infection for >29 years and no other underlying diseases. Based on further investigations, he was diagnosed with advanced HCC and refused surgery.Diagnosis:Based on the patient''s performance status, tumor status assessed by computed tomography, liver function, and percutaneous liver biopsy, he was diagnosed with advanced HCC Barcelona Clinic Liver Cancer Stage C.Interventions:The patient was administered a 200-mg oral dose of donafenib twice-daily.Outcomes:The patient was followed-up from the time of diagnosis. He received donafenib for 31 months, and the progression-free survival time was 31 months (from May 2017 to December 2019); the overall survival time was not reached. The patient reported little abdominal distension with no other obvious discomfort while taking the medication.Lesson:Donafenib showed good efficacy for the treatment of advanced HCC, with mild side effects. Deuterium-containing drugs seem to be a promising avenue for medical innovation.     

肝脏脾植入误诊为肝细胞癌1例

本文报道了1例肝脏左外叶脾植入误诊为肝左叶小肝癌的病例,详细描述其临床特点、实验室检查、超声、磁共振及病理结果,并进行讨论。