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En Bloc lumpectomy of T12 vertebra for progressive hepatocellular carcinoma metastases following liver transplantation: A case report.

整块T12 椎体肿瘤切除术治疗肝移植术后进展性肝细胞癌转移 1 例。

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000018756
  • 作者列表:"Hu JG","Lu Y","Lin XJ
  • 发表时间:2020-01-01
Abstract

RATIONALE:Liver transplantation (LT) is the preferred surgical option for the treatment of early hepatocellular carcinoma (HCC). In contrast, surgical treatment of progressive HCC metastasized to the spine following LT constitutes a considerable challenge. Here, we report the first case of progressive HCC metastasized to the T12 vertebra after local radiotherapy, treated successfully with en bloc lumpectomy following LT for HCC. PATIENT CONCERNS:A 40-year-old man who had undergone LT for the treatment of HCC 2 months prior presented to our clinic with symptoms of progressive back pain. Magnetic resonance imagining (MRI) and positron emission tomography (PET) examinations showed a solitary metastasis at T12 without recurrence in the liver or metastasis to other organs. DIAGNOSES:The patient was diagnosed with HCC metastasized to the T12 vertebra after liver transplantation. INTERVENTIONS:Local radiation therapy of the T12 vertebra was performed; however, the lesion continued to grow one month after irradiation. Accordingly, the patient was treated with en bloc lumpectomy of the T12 vertebra. After surgery, the patient reported significant pain relief. At 11 months post-surgery, a C4 metastasis with spinal cord compression was revealed by MRI. Multiple grafted liver metastases were also detected by ultrasound along with several lung metastases, which were discovered by X-ray. The patient was treated with a pedicle screw system and a mesh cage filled with frozen autografts for C4 metastasis. OUTCOMES:The patient died 15 months after liver transplantation due to recurrence in the liver and metastasis to the lung. LESSONS:En bloc lumpectomy may be a viable therapeutic option for patients with progressive solitary spinal metastases after LT refractory to radiotherapy. Use of immunosuppressive therapy after LT may significantly inhibit immune function, making patients more susceptible to HCC recurrence and bone metastasis.

摘要

理由: 肝移植 (LT) 是治疗早期肝细胞癌 (HCC) 的首选手术选择。相比之下,LT后转移至脊柱的进行性HCC的手术治疗构成了相当大的挑战。在此,我们报道了首例局部放疗后进展性HCC转移至T12 椎体的病例,成功地在LT后进行了整块肿块切除术治疗HCC。 患者关注: 1 例 40 岁男性,2 个月前接受过LT治疗HCC,就诊于我们诊所,症状为进行性背痛。磁共振成像 (MRI) 和正电子发射断层扫描 (PET) 检查显示T12 时出现单发转移,肝脏无复发或转移至其他器官。 诊断: 患者在肝移植后被诊断为HCC转移至T12 椎体。 干预措施: 对T12 椎体进行局部放射治疗; 然而,照射后一个月病灶继续生长。因此,患者接受了T12 椎体整块肿块切除术。手术后,患者报告疼痛明显缓解。术后 11 个月时,MRI显示C4 转移伴脊髓压迫。超声还发现了多发性移植肝转移灶,以及x线发现的几个肺转移灶。患者接受椎弓根螺钉系统和填充冷冻自体移植物的网状笼治疗C4 转移。 结果: 患者在肝移植后 15 个月死于肝脏复发和肺转移。 教训: 整块肿瘤切除术可能是LT放疗难治性后进行性单发脊柱转移瘤患者的可行治疗选择。LT后使用免疫抑制治疗可能会显著抑制免疫功能,使患者更容易发生HCC复发和骨转移。

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DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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