緩徐な経過を経て自然壊死を伴った巨大淡明細胞型肝細胞癌の1切除例

肝細胞癌（hepatocellular carcinoma；以下，HCCと略記）の中には淡明な細胞質を有する淡明細胞型が存在するが，本邦では比較的まれとされている．今回，我々は自然壊死を伴う大型の淡明細胞型HCCを経験した．症例は71歳の女性で，3年前より肝右葉に巨大な囊胞性腫瘤を認めたが，生検で悪性所見が得られなかったため経過観察となっていた．今回フォロー中に腫瘤は増大し周囲に複数の結節影が出現したため再度腫瘍生検を行い，悪性所見を認めたため精査治療目的に紹介となり肝右葉切除術を行った．腫瘍径は10 cm，肉眼型は単純結節周囲増殖型であり，主腫瘍中心部の囊胞性部分は凝固壊死に陥っていた．また...

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Published in日本消化器外科学会雑誌 Vol. 52; no. 9; pp. 513 - 520
Main Authors 富永, 正寛, 小林, 杏奈, 藤野, 泰宏, 山根, 秘我, 吉田, 佐智子, 吉田, 俊彦, 山岸, 農, 松本, 拓
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 01.09.2019
Subjects
淡明細胞
肝切除
肝細胞癌
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2018.0105

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Abstract 肝細胞癌（hepatocellular carcinoma；以下，HCCと略記）の中には淡明な細胞質を有する淡明細胞型が存在するが，本邦では比較的まれとされている．今回，我々は自然壊死を伴う大型の淡明細胞型HCCを経験した．症例は71歳の女性で，3年前より肝右葉に巨大な囊胞性腫瘤を認めたが，生検で悪性所見が得られなかったため経過観察となっていた．今回フォロー中に腫瘤は増大し周囲に複数の結節影が出現したため再度腫瘍生検を行い，悪性所見を認めたため精査治療目的に紹介となり肝右葉切除術を行った．腫瘍径は10 cm，肉眼型は単純結節周囲増殖型であり，主腫瘍中心部の囊胞性部分は凝固壊死に陥っていた．また，囊胞壁および周囲の複数の結節は大部分が肝細胞由来の淡明細胞癌であった．背景肝に炎症や線維化は認めなかった．大型の淡明細胞型HCCの報告はまれであり，かつ自然経過での凝固壊死を伴っていることも含め示唆に富む症例と考えられた．
AbstractList 肝細胞癌（hepatocellular carcinoma；以下，HCCと略記）の中には淡明な細胞質を有する淡明細胞型が存在するが，本邦では比較的まれとされている．今回，我々は自然壊死を伴う大型の淡明細胞型HCCを経験した．症例は71歳の女性で，3年前より肝右葉に巨大な囊胞性腫瘤を認めたが，生検で悪性所見が得られなかったため経過観察となっていた．今回フォロー中に腫瘤は増大し周囲に複数の結節影が出現したため再度腫瘍生検を行い，悪性所見を認めたため精査治療目的に紹介となり肝右葉切除術を行った．腫瘍径は10 cm，肉眼型は単純結節周囲増殖型であり，主腫瘍中心部の囊胞性部分は凝固壊死に陥っていた．また，囊胞壁および周囲の複数の結節は大部分が肝細胞由来の淡明細胞癌であった．背景肝に炎症や線維化は認めなかった．大型の淡明細胞型HCCの報告はまれであり，かつ自然経過での凝固壊死を伴っていることも含め示唆に富む症例と考えられた．
Author 小林, 杏奈
山根, 秘我
山岸, 農
富永, 正寛
吉田, 俊彦
吉田, 佐智子
藤野, 泰宏
松本, 拓
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References 14) Wu PC, Lai CL, Lam KC, Lok AS, Lin HJ. Clear cell carcinoma of liver. An ultrastructural study. Cancer. 1983 Aug;52(3):504–507.
23) Li T, Fan J, Qin LX, Zhou J, Sun HC, Qiu SJ, et al. Risk factors, prognosis, and management of early and late intrahepatic recurrence after resection of primary clear cell carcinoma of the liver. Ann Surg Oncol. 2011 Jul;18(7):1955–1963.
21) Li ZY, Bi XY, Zhao JJ, Zhao H, Zhou JG, Huang Z, et al. Clinicopathological and prognostic analysis of primary clear cell carcinoma of the liver. Zhonghua Zhong Liu Za Zhi. 2013 Feb;35(2):140–143.
5) Emile JF, Lemoine A, Azoulay D, Debuire B, Bismuth H, Reynès M. Histological, genomic and clinical heterogeneity of clear cell hepatocellular carcinoma. Histopathology. 2001 Mar;38(3):225–231.
8) Liu Z, Ma W, Li H, Li Q. Clinicopathological and prognostic features of primary clear cell carcinoma of the liver. Hepatol Res. 2008 Mar;38(3):291–299.
4) Clayton EF, Furth EE, Ziober A, Xu T, Yao Y, Hwang PG, et al. A case of primary clear cell hepatocellular carcinoma in a non-cirrhotic liver: an immunohistochemical and ultrastructural study. Rare Tumors. 2012 Apr;4(2):e29.
2) Lai CL, Wu PC, Lam KC, Todd D. Histologic prognostic indicators in hepatocellular carcinoma. Cancer. 1979 Nov;44(5):1677–1683.
19) Murakata LA, Ishak KG, Nzeako UC. Clear cell carcinoma of the liver: a comparative immunohistochemical study with renal clear cell carcinoma. Mod Pathol. 2000 Aug;13(8):874–881.
6) Kashala LO, Conne B, Kalengayi MM, Kapanci Y, Frei PC, Lambert PH. Histopathologic features of hepatocellular carcinoma in Zaire. Cancer. 1990 Jan;65(1):130–134.
12) 市川 仁美，清水 恵理奈，長澤 正通，芳澤 社，舘野 誠，室久 剛，ほか．clear cell typeの肝細胞癌の1例．肝臓．2010;51(11):674–680.
15) Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol. 2000 Aug;33(2):282–289.
9) Lao XM, Zhang YQ, Jin X, Lin XJ, Guo RP, Li GH, et al. Primary clear cell carcinoma of liver—clinicopathologic features and surgical results of 18 cases. Hepatogastroenterology. 2006 Jan–Feb;53(67):128–132.
1) Yang SH, Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on clear cell hepatocellular carcinoma. Pathol Int. 1996;46:503–509.
17) Hermsen IG, Gelderblom H, Kievit J, Romijn JA, Haak HR. Extremely long survival in six patients despite recurrent and metastatic adrenal carcinoma. Eur J Endocrinol. 2008 Jun;158(6):911–919.
7) Liu QY, Li HG, Gao M, Lin XF, Li Y, Chen JY. Primary clear cell carcinoma in the liver: CT and MRI findings. World J Gastroenterol. 2011 Feb;17(7):946–952.
25) Ji SP, Li Q, Dong H. Therapy and prognostic features of primary clear cell carcinoma of the liver. World J Gastroenterol. 2010 Feb;16(6):764–769.
13) Orsatti G, Arnold MM, Paronetto F. DNA image cytometric analysis of primary clear cell carcinoma of the liver. Arch Pathol Lab Med. 1994 Dec;118(12):1226–1229.
11) Li Z, Wu X, Bi X, Zhang Y, Huang Z, Lu H, et al. Clinicopathological features and surgical outcomes of four rare subtypes of primary liver carcinoma. Chin J Cancer Res. 2018 Jun;30(3):364–372.
10) Liu JH, Tsai HL, Hsu SM, Hu DH, Chen SS. Clear cell and non-clear cell hepatocellular carcinoma: a case report and literature review. Kaohsiung J Med Sci. 2004 Feb;20(2):78–82.
18) Kawagishi N, Shirahata Y, Ishida K, Satoh K, Enomoto Y, Akamatsu Y, et al. Hepatic resection of giant metastatic tumor from clear cell carcinoma of the ovary. J Hepatobiliary Pancreat Surg. 2005;12(2):155–158.
16) Oliveira AM, Erickson LA, Burgart LJ, Lloyd RV. Differentiation of primary and metastatic clear cell tumors in the liver by in situ hybridization for albumin messenger RNA. Am J Surg Pathol. 2000 Feb;24(2):177–182.
24) Takahashi A, Saito H, Kanno Y, Abe K, Yokokawa J, Irisawa A, et al. Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman. World J Gastroenterol. 2008 Jan;14(1):129–131.
20) Ozcan A, Shen SS, Hamilton C, Anjana K, Coffey D, Krishnan B, et al. PAX 8 expression in non-neoplastic tissues, primary tumors, and metastatic tumors: a comprehensive immunohistochemical study. Mod Pathol. 2011 Jun;24(6):751–764.
22) Ishigami K, Yoshimitsu K, Nishihara Y, Irie H, Asayama Y, Tajima T, et al. Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology. 2009 Feb;250(2):435–443.
3) Chung YE, Park MS, Park YN, Lee HJ, Seok JY, Yu JS, et al. Hepatocellular carcinoma variants: radiologic-pathologic correlation. AJR Am J Roentgenol. 2009 Jul;193(1):W7–13.
References_xml – reference: 9) Lao XM, Zhang YQ, Jin X, Lin XJ, Guo RP, Li GH, et al. Primary clear cell carcinoma of liver—clinicopathologic features and surgical results of 18 cases. Hepatogastroenterology. 2006 Jan–Feb;53(67):128–132.
– reference: 4) Clayton EF, Furth EE, Ziober A, Xu T, Yao Y, Hwang PG, et al. A case of primary clear cell hepatocellular carcinoma in a non-cirrhotic liver: an immunohistochemical and ultrastructural study. Rare Tumors. 2012 Apr;4(2):e29.
– reference: 25) Ji SP, Li Q, Dong H. Therapy and prognostic features of primary clear cell carcinoma of the liver. World J Gastroenterol. 2010 Feb;16(6):764–769.
– reference: 5) Emile JF, Lemoine A, Azoulay D, Debuire B, Bismuth H, Reynès M. Histological, genomic and clinical heterogeneity of clear cell hepatocellular carcinoma. Histopathology. 2001 Mar;38(3):225–231.
– reference: 23) Li T, Fan J, Qin LX, Zhou J, Sun HC, Qiu SJ, et al. Risk factors, prognosis, and management of early and late intrahepatic recurrence after resection of primary clear cell carcinoma of the liver. Ann Surg Oncol. 2011 Jul;18(7):1955–1963.
– reference: 15) Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol. 2000 Aug;33(2):282–289.
– reference: 17) Hermsen IG, Gelderblom H, Kievit J, Romijn JA, Haak HR. Extremely long survival in six patients despite recurrent and metastatic adrenal carcinoma. Eur J Endocrinol. 2008 Jun;158(6):911–919.
– reference: 20) Ozcan A, Shen SS, Hamilton C, Anjana K, Coffey D, Krishnan B, et al. PAX 8 expression in non-neoplastic tissues, primary tumors, and metastatic tumors: a comprehensive immunohistochemical study. Mod Pathol. 2011 Jun;24(6):751–764.
– reference: 3) Chung YE, Park MS, Park YN, Lee HJ, Seok JY, Yu JS, et al. Hepatocellular carcinoma variants: radiologic-pathologic correlation. AJR Am J Roentgenol. 2009 Jul;193(1):W7–13.
– reference: 6) Kashala LO, Conne B, Kalengayi MM, Kapanci Y, Frei PC, Lambert PH. Histopathologic features of hepatocellular carcinoma in Zaire. Cancer. 1990 Jan;65(1):130–134.
– reference: 8) Liu Z, Ma W, Li H, Li Q. Clinicopathological and prognostic features of primary clear cell carcinoma of the liver. Hepatol Res. 2008 Mar;38(3):291–299.
– reference: 19) Murakata LA, Ishak KG, Nzeako UC. Clear cell carcinoma of the liver: a comparative immunohistochemical study with renal clear cell carcinoma. Mod Pathol. 2000 Aug;13(8):874–881.
– reference: 21) Li ZY, Bi XY, Zhao JJ, Zhao H, Zhou JG, Huang Z, et al. Clinicopathological and prognostic analysis of primary clear cell carcinoma of the liver. Zhonghua Zhong Liu Za Zhi. 2013 Feb;35(2):140–143.
– reference: 18) Kawagishi N, Shirahata Y, Ishida K, Satoh K, Enomoto Y, Akamatsu Y, et al. Hepatic resection of giant metastatic tumor from clear cell carcinoma of the ovary. J Hepatobiliary Pancreat Surg. 2005;12(2):155–158.
– reference: 2) Lai CL, Wu PC, Lam KC, Todd D. Histologic prognostic indicators in hepatocellular carcinoma. Cancer. 1979 Nov;44(5):1677–1683.
– reference: 10) Liu JH, Tsai HL, Hsu SM, Hu DH, Chen SS. Clear cell and non-clear cell hepatocellular carcinoma: a case report and literature review. Kaohsiung J Med Sci. 2004 Feb;20(2):78–82.
– reference: 11) Li Z, Wu X, Bi X, Zhang Y, Huang Z, Lu H, et al. Clinicopathological features and surgical outcomes of four rare subtypes of primary liver carcinoma. Chin J Cancer Res. 2018 Jun;30(3):364–372.
– reference: 16) Oliveira AM, Erickson LA, Burgart LJ, Lloyd RV. Differentiation of primary and metastatic clear cell tumors in the liver by in situ hybridization for albumin messenger RNA. Am J Surg Pathol. 2000 Feb;24(2):177–182.
– reference: 14) Wu PC, Lai CL, Lam KC, Lok AS, Lin HJ. Clear cell carcinoma of liver. An ultrastructural study. Cancer. 1983 Aug;52(3):504–507.
– reference: 7) Liu QY, Li HG, Gao M, Lin XF, Li Y, Chen JY. Primary clear cell carcinoma in the liver: CT and MRI findings. World J Gastroenterol. 2011 Feb;17(7):946–952.
– reference: 12) 市川 仁美，清水 恵理奈，長澤 正通，芳澤 社，舘野 誠，室久 剛，ほか．clear cell typeの肝細胞癌の1例．肝臓．2010;51(11):674–680.
– reference: 1) Yang SH, Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on clear cell hepatocellular carcinoma. Pathol Int. 1996;46:503–509.
– reference: 13) Orsatti G, Arnold MM, Paronetto F. DNA image cytometric analysis of primary clear cell carcinoma of the liver. Arch Pathol Lab Med. 1994 Dec;118(12):1226–1229.
– reference: 24) Takahashi A, Saito H, Kanno Y, Abe K, Yokokawa J, Irisawa A, et al. Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman. World J Gastroenterol. 2008 Jan;14(1):129–131.
– reference: 22) Ishigami K, Yoshimitsu K, Nishihara Y, Irie H, Asayama Y, Tajima T, et al. Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology. 2009 Feb;250(2):435–443.
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Snippet 肝細胞癌（hepatocellular...
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SubjectTerms 淡明細胞
肝切除
肝細胞癌
Title 緩徐な経過を経て自然壊死を伴った巨大淡明細胞型肝細胞癌の1切除例
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