1例原发性肝脏鳞状细胞癌分析

Analysis of a case of primary squamous cell carcinoma of liver

目的总结原发性肝脏鳞状细胞癌(primary squamous cell carcinoma of liver,PSCCL)的临床表现、影像学表现并探讨其病因、组织来源、病理特点、诊断及鉴别诊断、治疗方法的选择及预后,以提高对该病的认识及合理诊治。方法回顾性分析四川大学华西医院诊治的1例PSCCL误诊为肝内胆管细胞癌患者的临床病理资料。结果该例患者以右肝占位收入院,术前影像学检查提示为肝内胆管细胞癌影像学特征,遂行右半肝切除术,术后病理检查结果诊断为PSCCL。结论 PSCCL术前诊断极为困难,与原发性肝癌难以鉴别,且容易忽略其他部位的鳞癌发生肝转移而导致肝转移瘤,往往经过术后病理诊断提示且经各项检查排除其他部位的原发灶后才得以明确诊断。PSCCL的治疗方式多种多样,但预后不佳,目前无统一的治疗原则,多以手术为主,术后辅以放化疗。目前,由于PSCCL的病因不明,机制不清,临床医生只能根据患者病情特点实施个体化治疗。

Objective To investigate misdiagnosis of primary squamous cell carcinoma of liver(PSCCL) as cholangiocarcinoma before operation and its clinical manifestations, imaging manifestations, etiology, histological origin,pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis, so as to improve understanding and reasonable diagnosis and treatment of disease. Method The clinicopathologic data of a case of PSCCL misdiagnosed as cholangiocarcinoma in the West China Hospital of Sichuan University were analyzed retrospectively. Results The patient was admitted to the West China Hospital of Sichuan University with the right hepatic space occupying. The preoperative imaging examination showed that the patient had the imaging characteristics of hepatic cholangiocarcinoma, then the right hemihepatectomy was performed. The postoperative pathological diagnosis was the PSCCL. Conclusions Preoperative diagnosis of PSCCL is extremely difficult and it is difficult to differentiate it from primary liver cancer, and it is easy to overlook liver metastasis’ s occurrence in other parts of the squamous cell carcinoma, which leads to liver metastasis. It is usually diagnosed by pathological diagnosis after operation, and then original lesions in other parts are excluded by various examinations. PSCCL is treated in a variety of ways, but it’s prognosis is not good. At present, there is no unified treatment principle, most of which are surgery, followed by postoperative radiotherapy and chemotherapy. In most cases, because PSCCL’s etiology is unknown and mechanism is not clear, clinicians can only implement individualized treatment according to patient’s condition.