- 期刊
Hepatic Inflammatory Pseudotumors with Portal Vein Thrombosis and Extremely Elevated α-Fetoprotein Level
肝臟發炎性假性腫瘤合併肝門靜脈栓塞及胎兒蛋白異常升高
摘要
肝臟發炎性假性腫瘤，是一種罕見非癌病變。因為肝臟發炎性假性腫瘤在超音波及電腦斷層掃描上與肝癌極為相似，因此無法以影像檢查作為鑑別診斷工具。胎兒蛋白質是目前已知可靠的非侵入性鑑別診斷工具。一名61歲男性C型肝炎帶原者，發現右肝腫瘤合併異常上升胎兒蛋白，斷層掃描及超音波顯示典型右肝肝臟惡性腫瘤，合併肝門靜脈侵犯及血管內腫瘤栓塞，病患接受右肝切除及腫瘤栓塞摘取手術。病理報告顯示肝臟發炎性假性腫瘤。術後胎兒蛋自立刻下降，連續兩年術後超音波亦不見腫瘤復發情形。臨床上，對於這位屬於好發肝癌高危險群病患，我們可藉由定期胎兒蛋白及超音波追蹤，更容易早期檢測出肝癌的發生。肝臟發炎性假性腫瘤及肝癌的鑑別診斷，可能仍需倚賴切片檢查。對於慢性肝炎患者若同時罹患肝臟發炎性假性腫瘤時，手術切除仍舊扮演重要角色。
並列摘要
Hepatic inflammatory pseudotumors (HIPTs) are rare non-neoplastic lesions. Because HIPTs often mimic hepatocellular carcinoma on ultrasonography and computerized tomography scan, they are difficult to distinguish from malignant lesions preoperatively even with advanced image studies. According to the literature, elevated a-fetoprotein might be the only possible non-invasive test to differentiate hepatic inflammatory pseudotumors from hepatocellular carcinoma. A 61-year-old male hepatitis C virus carrier presented with a hepatic tumor and elevated a-fetoprotein levels (α-fetoprotein=11, 241 μg/L). Abdominal computerized tomography and ultrasonograhy revealed typical signs of right hepatic lobe hepatocellular carcinoma with right intrahepatic portal vein invasion and tumor thrombi formation. He underwent trisegmentectomy (Seg. 5, 6, 7 according to Couinaud’s classification) and portal vein thrombectomy. The pathological diagnosis was HIPT. Postoperative ct-fetoprotein level lowered immediately and long-term follow-up with ultrasonography has revealed no evidence of tumor regrowth for the past two years. Elevated a-fetoprotein is a specific tool for detecting the occurrence of hepatocellular carcinoma in patients with underlying chronic viral hepatitis. However, our patient had extremely elevated α-fetoprotein, but pathology revealed HIPT. This suggests that the differentiation between inflammatory pseudotumors and hepatocellular carcinoma requires biopsy. Surgical intervention still plays a role in long-term follow-up for chronic viral hepatitis carriers who also have hepatic inflammatory pseudotumors.
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延伸閱讀
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