Multifocal Inflammatory Pseudotumors in a Patient with Cirrhotic Liver and Very High Alpha-Fetoprotein: Report of a Case

肝硬化併發多發性肝臓發炎假性腫瘤及高胎兒蛋白：一病例報告

胡志棠(Chi-Tan Hu) ； 林憲宏(Hsien-Hong Lin)

《臺灣消化醫學雜誌》 21卷2期 (2004/06) Pp. 155-162

https://doi.org/10.6557/GJT.200406_21(2).0006

摘要

肝臓發炎假性腫瘤雖爲良性病變，如沒有肝臓切片卻不易與肝細胞癌區分。在台灣肝細胞癌爲主要癌症之一，且其發生80%以上與肝硬化有關；另外，多數的肝細胞癌症人皆患有慢性B型或C型肝炎。我們報告一位55歲患有慢性C型肝炎和肝硬化的病人共同併發肝臓及疑似肺部發炎假性腫瘤。不但影像分析難與肝細胞癌併肺部轉移區分，其極高的胎兒蛋白數值(305，620ng/mL)更提示腫瘤極可能肝細胞癌。然而，出院後追蹤發現肝臓的多發性腫瘤漸漸縮小，且兩側肺部腫瘤經數個月後消失，回溯住院期間僅曾使用低劑最的類固醇和抗生素治療。胎兒蛋白的數值隨著肝臓腫瘤的縮小和肺部腫瘤的消失而降低。該個案最後經肝臓腫瘤多處切片檢查證實爲肝臓發炎假性腫瘤。藉此病例提示肝細胞癌的鑑別診斷必須包括肝臓發炎假性腫瘤，於肝細胞癌的好發地區尤應注意判別，縱使胎兒蛋白數值異常偏高。

關鍵字

肝臓發炎假性腫瘤 ； 胎兒蛋白 ； 肝細胞癌

並列摘要

Hepatic inflammatory pseudotumor (IPT) is a rare benign lesion that is not easy to be differentiated from hepatocellular carcinoma (HCC) without liver biopsy. In Taiwan, HCC is one of the most common cancers, and up to 80% of cases are related to liver cirrhosis; besides, most cases of HCC in Taiwan have chronic hepatitis B or C. We describe a 55-year-old man with chronic hepatitis C and liver cirrhosis who was diagnosed as having hepatic and probable pulmonary IPTs concomitantly. The imaging appearances were clinically indistinguishable from HCC with lung metastasis. The extremely high alpha-fetoprotein level (305, 620ng/mL) in this cirrhotic patient suggested the hepatic lesions were HCC but this was not the case. The hepatic tumors regressed and the pulmonary nodules vanished subsequently without specific treatment except the use of corticosteroid and antibiotics during hospitalization. Alpha-fetoprotein level decreased with the size of these multiple hepatic IPTs in regression. Percutaneous coaxial multiple liver biopsies from the regressing hepatic tumors confirmed the diagnosis of hepatic IPTs. Special attention should be paid to this unusual condition, particularly in regions where HCC is prevalent.

並列關鍵字

hepatic inflammatory pseudotumor ； alpha-fetoprotein ； hepatocellular carcinoma