复发性成人肝脏纤维组织细胞瘤伴破裂出血1例MDT讨论
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摘要
目的总结1例成人肝脏纤维组织细胞瘤多次复发并伴有破裂出血患者的诊治经过及经验。方法回顾性分析中国医科大学附属盛京医院于2018年5月收治的1例在术前行MDT讨论的复发性成人纤维组织细胞瘤伴破裂出血患者的资料,对该患者多次复发破裂出血的原因以及诊治经验进行总结分析。结果该患者曾行2次手术,一般情况良好,经影像科、肿瘤科、介入科和肝胆外科医师多学科讨论后,认为行手术治疗为最佳治疗方案。与患者及家属充分沟通后,选择了开腹肿瘤切除术,手术顺利。手术时间278 min,术中出血约100 mL,未输血。术后无出血、腹腔感染、胃瘫等并发症发生,于术后第13天顺利出院。第3次术后已获访8个月,术后6个月时肿瘤再次复发,口服甲磺酸阿帕替尼片行靶向治疗1个月余,继续随访治疗效果。结论复发性成人纤维组织细胞瘤伴破裂出血临床罕见,治疗主要以手术切除为基础,术后结合包括放化疗、分子靶向以及免疫药物治疗在内的综合治疗,其近期疗效较满意,远期疗效还需进一步观察。
Objective To summarize the experience of diagnosis and treatment of a case of adult hepatic fibrohistiocytoma with recurrent rupture and hemorrhage. Methods Retrospective analysis on this case of recurrent adult fibrohistiocytoma with rupture and hemorrhage admitted to Shengjing Hospital Affiliated to China Medical University in May 2018 was conducted, discussion on MDT was conducted before surgery, and the causes of recurrent rupture and hemorrhage, as well as the experience of diagnosis and treatment were summarized and analyzed.Results This patient was generally in good condition. After MDT discussions among the imaging department, oncology department, interventional department, and hepatobiliary surgeons, it was considered that surgical treatment was the best treatment scheme. After full communication with the patient and his family, the patient had chosen open tumor resection and the operation was smooth. The operation time was 278 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroparesis, and other complications occurred after the operation, and the patient was discharged successfully on the 13~(th) day after the operation. The patient had been interviewed for 8 months and the tumor recurred again 1 month ago. Currently, oral apatinib had been targeted for treatment for more than 1 month, and the follow-up treatment continued. Conclusions Recurrent adult fibrous histiocytoma with rupture and hemorrhage is rare in clinical practice, and the treatment is mainly based on surgical resection. Postoperative comprehensive treatment combined with radiotherapy, chemotherapy, molecular targeting, and immunotherapy is the main treatment. Its short-term efficacy is satisfactory, but long-term efficacy still needs to be further observed.
Objective To summarize the experience of diagnosis and treatment of a case of adult hepatic fibrohistiocytoma with recurrent rupture and hemorrhage. Methods Retrospective analysis on this case of recurrent adult fibrohistiocytoma with rupture and hemorrhage admitted to Shengjing Hospital Affiliated to China Medical University in May 2018 was conducted, discussion on MDT was conducted before surgery, and the causes of recurrent rupture and hemorrhage, as well as the experience of diagnosis and treatment were summarized and analyzed.Results This patient was generally in good condition. After MDT discussions among the imaging department, oncology department, interventional department, and hepatobiliary surgeons, it was considered that surgical treatment was the best treatment scheme. After full communication with the patient and his family, the patient had chosen open tumor resection and the operation was smooth. The operation time was 278 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroparesis, and other complications occurred after the operation, and the patient was discharged successfully on the 13~(th) day after the operation. The patient had been interviewed for 8 months and the tumor recurred again 1 month ago. Currently, oral apatinib had been targeted for treatment for more than 1 month, and the follow-up treatment continued. Conclusions Recurrent adult fibrous histiocytoma with rupture and hemorrhage is rare in clinical practice, and the treatment is mainly based on surgical resection. Postoperative comprehensive treatment combined with radiotherapy, chemotherapy, molecular targeting, and immunotherapy is the main treatment. Its short-term efficacy is satisfactory, but long-term efficacy still needs to be further observed.
引文
1姜喜远,谢远哲,王艳华,等.肝脏巨大恶性纤维组织细胞瘤伴破裂出血1例报告.吉林医学, 2015, 36(15):3464-3465.
2 Sato A, Ishida H, Komatsuda T, et al. Spontaneous ruptured hepatic malignant fibrous histiocytoma. J Med Ultrason(2001)2006, 33(4):255-256.
3张雪峰,易大勇,李孝舜.肝脏巨大黏液型恶性纤维组织细胞瘤CT表现一例.中华放射学杂志, 2014, 48(12):1056-1057.
4 Boxberg M, Steiger K, Lenze U, et al. PD-L1 and PD-1 and characterization of tumor-infiltrating lymphocytes in high grade sarcomas of soft tissue-prognostic implications and rationale for immunotherapy. Oncoimmunology, 2017, 7(3):e1389366.
5刘立刚,何晓东,李玉民,等.胰腺恶性纤维组织细胞瘤的诊治(附1例报道并文献复习).中国普外基础与临床杂志, 2009,16(8):658-660.
6O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer,1964, 17:1445-1455.
7 Liu Y, Xu B. Primary hepatic malignant fibrous histiocytoma on PET/CT. Clin Nucl Med, 2018, 43(6):e189-e191.
8Conran RM, Stocker JT. Malignant fibrous histiocytoma of the liver–a case report. Am J Gastroenterol, 1985, 80(10):813-815.
9 Das A, Arya SV, Soni N, et al. A rare presentation of hepatic and splenic cystic malignant fibrous histiocytoma:a case report and literature review. Int J Surg Case Rep, 2013, 4(1):139-141.
10Dong J, An W, Ma W, et al. Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma:a report of two cases. Oncol Lett, 2014, 8(5):2150-2154.
11 Mass JB, Talmon G. Undifferentiated pleomorphic sarcoma of liver:case report and review of the literature. Case Rep Pathol,2018, 2018:8031253.
12Tan Y, Xiao EH. Rare hepatic malignant tumors:dynamic CT,MRI, and clinicopathologic features:with analysis of 54 cases and review of the literature. Abdom Imaging, 2013, 38(3):511-526.
13 Tong Y, Yu H, Shen B, et al. Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava:a case report and literature review. Medicine(Baltimore), 2017, 96(23):e7110.
14Yao D, Dai C. Clinical characteristics of the primary hepatic malignant fibrous histiocytoma in China:case report and review of the literature. World J Surg Oncol, 2012, 10:2.
15 祁佩红,史大鹏,郑红伟,等.腹部原发性恶性纤维组织细胞瘤的CT表现.实用放射学杂志, 2016, 32(7):1056-1058, 1062.
16祁佩红,史大鹏,郑红伟,等.肝脏原发性恶性纤维组织细胞瘤的CT表现.中华肝胆外科杂志, 2015, 21(10):654-657.
17 金菲,陈小冬,吴晓英,等.肝纤维肉瘤1例报告.山东医药,2016, 56(17):109.
18史芳芳,安维民,董景辉.肝脏原发性纤维肉瘤的MRI表现与分析.中国医学装备, 2018, 15(3):62-65.
19 刘孟锋,刘连新.原发性肝癌自发性破裂出血的诊疗现状.医学综述, 2017, 23(16):3193-3196, 3201.
20胡章国,蒋国兴.乙肝病毒感染与肝癌自发性破裂相关性研究的进展.中国普外基础与临床杂志, 2013, 20(11):1325-1328.
21 Caldeira A, Martin-Carreras F, Pereira E, et al. Malignant fibrous histiocytoma–a rare hepatic tumor. Rev Esp Enferm Dig, 2010,102(2):146-147.
22Harman M, Nart D, Acar T, et al. Primary mesenchymal liver tumors:radiological spectrum, differential diagnosis, and pathologic correlation. Abdom Imaging, 2015, 40(5):1316-1330.
23 Hu JS, Gupta S, Chang SK. Primary hepatic inflammatory malignant fibrous histiocytoma:report of a rare entity and diagnostic pitfall mimicking a liver abscess. Pathology, 2013, 45(4):430-432.
24Dinges S, Budach V, Budach W, et al. Local recurrences of soft tissue sarcomas in adults:a retrospective analysis of prognostic factors in 102 cases after surgery and radiation therapy. Eur J Cancer, 1994, 30A(11):1636-1642.
25 Huang H, Cheville JC, Pan Y, et al. PTEN induces chemosensitivity in PTEN-mutated prostate cancer cells by suppression of Bcl-2expression. J Biol Chem, 2001, 276(42):38830-38836.
2 Sato A, Ishida H, Komatsuda T, et al. Spontaneous ruptured hepatic malignant fibrous histiocytoma. J Med Ultrason(2001)2006, 33(4):255-256.
3张雪峰,易大勇,李孝舜.肝脏巨大黏液型恶性纤维组织细胞瘤CT表现一例.中华放射学杂志, 2014, 48(12):1056-1057.
4 Boxberg M, Steiger K, Lenze U, et al. PD-L1 and PD-1 and characterization of tumor-infiltrating lymphocytes in high grade sarcomas of soft tissue-prognostic implications and rationale for immunotherapy. Oncoimmunology, 2017, 7(3):e1389366.
5刘立刚,何晓东,李玉民,等.胰腺恶性纤维组织细胞瘤的诊治(附1例报道并文献复习).中国普外基础与临床杂志, 2009,16(8):658-660.
6O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer,1964, 17:1445-1455.
7 Liu Y, Xu B. Primary hepatic malignant fibrous histiocytoma on PET/CT. Clin Nucl Med, 2018, 43(6):e189-e191.
8Conran RM, Stocker JT. Malignant fibrous histiocytoma of the liver–a case report. Am J Gastroenterol, 1985, 80(10):813-815.
9 Das A, Arya SV, Soni N, et al. A rare presentation of hepatic and splenic cystic malignant fibrous histiocytoma:a case report and literature review. Int J Surg Case Rep, 2013, 4(1):139-141.
10Dong J, An W, Ma W, et al. Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma:a report of two cases. Oncol Lett, 2014, 8(5):2150-2154.
11 Mass JB, Talmon G. Undifferentiated pleomorphic sarcoma of liver:case report and review of the literature. Case Rep Pathol,2018, 2018:8031253.
12Tan Y, Xiao EH. Rare hepatic malignant tumors:dynamic CT,MRI, and clinicopathologic features:with analysis of 54 cases and review of the literature. Abdom Imaging, 2013, 38(3):511-526.
13 Tong Y, Yu H, Shen B, et al. Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava:a case report and literature review. Medicine(Baltimore), 2017, 96(23):e7110.
14Yao D, Dai C. Clinical characteristics of the primary hepatic malignant fibrous histiocytoma in China:case report and review of the literature. World J Surg Oncol, 2012, 10:2.
15 祁佩红,史大鹏,郑红伟,等.腹部原发性恶性纤维组织细胞瘤的CT表现.实用放射学杂志, 2016, 32(7):1056-1058, 1062.
16祁佩红,史大鹏,郑红伟,等.肝脏原发性恶性纤维组织细胞瘤的CT表现.中华肝胆外科杂志, 2015, 21(10):654-657.
17 金菲,陈小冬,吴晓英,等.肝纤维肉瘤1例报告.山东医药,2016, 56(17):109.
18史芳芳,安维民,董景辉.肝脏原发性纤维肉瘤的MRI表现与分析.中国医学装备, 2018, 15(3):62-65.
19 刘孟锋,刘连新.原发性肝癌自发性破裂出血的诊疗现状.医学综述, 2017, 23(16):3193-3196, 3201.
20胡章国,蒋国兴.乙肝病毒感染与肝癌自发性破裂相关性研究的进展.中国普外基础与临床杂志, 2013, 20(11):1325-1328.
21 Caldeira A, Martin-Carreras F, Pereira E, et al. Malignant fibrous histiocytoma–a rare hepatic tumor. Rev Esp Enferm Dig, 2010,102(2):146-147.
22Harman M, Nart D, Acar T, et al. Primary mesenchymal liver tumors:radiological spectrum, differential diagnosis, and pathologic correlation. Abdom Imaging, 2015, 40(5):1316-1330.
23 Hu JS, Gupta S, Chang SK. Primary hepatic inflammatory malignant fibrous histiocytoma:report of a rare entity and diagnostic pitfall mimicking a liver abscess. Pathology, 2013, 45(4):430-432.
24Dinges S, Budach V, Budach W, et al. Local recurrences of soft tissue sarcomas in adults:a retrospective analysis of prognostic factors in 102 cases after surgery and radiation therapy. Eur J Cancer, 1994, 30A(11):1636-1642.
25 Huang H, Cheville JC, Pan Y, et al. PTEN induces chemosensitivity in PTEN-mutated prostate cancer cells by suppression of Bcl-2expression. J Biol Chem, 2001, 276(42):38830-38836.