肝细胞肝癌合并原发性胃部非霍奇金淋巴瘤的诊治特点

Characteristic of diagnosis and treatment of hepatocellular carcinoma complicated with primary gastric non-Hodgkin's lymphoma: a case report

目的探讨肝细胞肝癌(肝癌)合并原发性胃部非霍奇金淋巴瘤(PGNHL)的诊治特点。方法回顾性研究2006年10月中山大学附属第三医院收治的1例肝癌合并PGNHL患者。患者已签署知情同意书,符合医学伦理学规定。分析其病史、诊治经过、治疗方法、疗效和血常规、肝功能、病毒血清学、腹部超声、计算机体层摄影术(CT)和电子胃镜等临床资料,总结该病诊治特点。结果该例患者男性,76岁,因进行性疲劳并食欲减退1个月入院。既往有30年的乙型肝炎病毒(HBV)感染史。术前腹部超声及CT检查结果均考虑胃癌肝转移,电子胃镜检查示胃腔内巨大肿块,活体组织检查(活检)示低分化腺癌。入院后经积极术前准备在气管插管全身麻醉下行全胃、肝左外叶、脾切除以及胰尾部肿瘤根治性切除术。术后病理检查示胃部弥漫性大B细胞淋巴瘤、肝脏中分化肝癌。术后给予化学药物治疗(化疗)。出院后随访67个月,无复发征象。结论该例肝癌合并PGNHL的发生可能与HBV长期感染密切相关,无特征性临床表现,诊断主要靠病理学确诊。根治性切除手术是延长患者长期生存期的重要手段。

Objective To explore the characteristic of diagnosis and treatment of hepatocellular carcinoma （HCC） complicated with primary gastric non-Hodgkin＇s lymphoma （PGNHL）. Methods Retrospective analysis was performed in one patient who was diagnosed with HCC complicated with PGNHL in the Third Affiliated Hospital of Sun Yat-sen University in October 2006. Local ethical committee approval had been received and that the informed consent of the subject was obtained. The clinical data including case history, treatment procedures, efficacy, blood routine, liver function, viral serology, abdominal ultrasound, abdominal computed tomography （CT）, electronic gastroscopy examination as well as treatment were analyzed and the treatment characteristics were summarized. Results The patient （male,76 years old） was admitted in hospital for progressive fatigue and loss of appetite with a 30-year hepatitis B virus infection history. Both preoperative abdominal ultrasound and CT indicated gastric cancer with liver metastasis. The electronic gastroscope test showed huge mass in the gastral cavity. The biopsy indicated poorly differentiated adenocarcinoma. The patient underwent total gastrectomy and resection of all metastasis including left lateral lobe of liver, spleen and the tail of pancreas. The postoperative pathological examination demonstrated two different pathological types： gastric diffuse large B-cell lymphoma and moderately-differentiated HCC. The patient received chemotherapy and was followed up for 67 months after the operation. No recurrence was observed. Conclusions HCC complicated with PGNHL is rare and might be closely related to the long-term hepatitis B virus （HBV） infection. Patients with HCC and PGNHL have no specific clinical manifestations. The diagnosis is confirmed by pathological examination. Radical resection is the preferred treatment for better prgonosis.