単発性肝転移と多発性骨転移を来し肝細胞癌との鑑別が困難であった分化型甲状腺癌の1例
症例は56歳の女性で，肺癌検診精査中に肝腫瘍を指摘，当院を受診した．甲状腺乳頭癌に対し18年前に甲状腺右葉切除術を，腺腫様甲状腺腫に対し16年前に甲状腺全摘術を受けている．術前の血液検査ではサイログロブリンの著明な上昇を認めた．CTでは肝外側区域に早期相で濃染され，後期相でwash outされる，中心性瘢痕と被膜様構造を有する腫瘍を認めた．MRIでは左第7肋骨と第1腰椎に肝腫瘍と同時相で造影される腫瘍を認め，全身骨シンチでは第6胸椎と左第7肋骨に集積を認めた．以上から単発性肝腫瘍および多発性骨転移と診断したが，肝腫瘍は肝細胞癌と甲状腺癌の肝転移の可能性があった．肝腫瘍は切除可能と判断し外側区域...
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| Published in | 日本消化器外科学会雑誌 Vol. 44; no. 3; pp. 266 - 272 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
01.03.2011
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| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.44.266 |
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| Abstract | 症例は56歳の女性で，肺癌検診精査中に肝腫瘍を指摘，当院を受診した．甲状腺乳頭癌に対し18年前に甲状腺右葉切除術を，腺腫様甲状腺腫に対し16年前に甲状腺全摘術を受けている．術前の血液検査ではサイログロブリンの著明な上昇を認めた．CTでは肝外側区域に早期相で濃染され，後期相でwash outされる，中心性瘢痕と被膜様構造を有する腫瘍を認めた．MRIでは左第7肋骨と第1腰椎に肝腫瘍と同時相で造影される腫瘍を認め，全身骨シンチでは第6胸椎と左第7肋骨に集積を認めた．以上から単発性肝腫瘍および多発性骨転移と診断したが，肝腫瘍は肝細胞癌と甲状腺癌の肝転移の可能性があった．肝腫瘍は切除可能と判断し外側区域切除と肋骨生検を施行した．病理組織学的検査で両病変は，分化型甲状腺癌の転移と診断された．甲状腺乳頭癌の単発性肝転移は非常にまれで，文献的考察を加え報告する． |
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| AbstractList | 症例は56歳の女性で，肺癌検診精査中に肝腫瘍を指摘，当院を受診した．甲状腺乳頭癌に対し18年前に甲状腺右葉切除術を，腺腫様甲状腺腫に対し16年前に甲状腺全摘術を受けている．術前の血液検査ではサイログロブリンの著明な上昇を認めた．CTでは肝外側区域に早期相で濃染され，後期相でwash outされる，中心性瘢痕と被膜様構造を有する腫瘍を認めた．MRIでは左第7肋骨と第1腰椎に肝腫瘍と同時相で造影される腫瘍を認め，全身骨シンチでは第6胸椎と左第7肋骨に集積を認めた．以上から単発性肝腫瘍および多発性骨転移と診断したが，肝腫瘍は肝細胞癌と甲状腺癌の肝転移の可能性があった．肝腫瘍は切除可能と判断し外側区域切除と肋骨生検を施行した．病理組織学的検査で両病変は，分化型甲状腺癌の転移と診断された．甲状腺乳頭癌の単発性肝転移は非常にまれで，文献的考察を加え報告する． |
| Author | 俵藤, 正信 安田, 是和 佐田, 尚宏 森嶋, 計 田原, 真紀子 仁平, 芳人 仁木, 利郎 |
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| Copyright | 2011 一般社団法人 日本消化器外科学会 |
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| References | 19) 中野基一郎，丹黒 章．甲状腺乳頭癌の肝・骨転移にI-131内用療法が奏功した1例．日本臨床外科学会雑誌．2007;68:1908-13. 24) Liu YW, Chen CL, Chen YS, et al. Needle tract implantation of hepatocellular carcinoma after fine needle biopsy. Dig Dis Sci. 2007;52:228-31. 25) Ichikawa T, Federle MP, Grazioli L, et al. Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases. Radiology. 1999;213:352-61. 12) Ohwada S, Iino Y, Hosomura Y, et al. Solitary Metastasis from Papillary Thyroid carcinoma in Cirrhotic Liver with Hepatocellular Carcinoma. Jpn J Clin Oncol. 1993;23:309-12. 3) Sampson E, Brierley JD, Le LW, et al. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer. 2007;110:1451-6. 2) Hundahl SA, Fleming ID, Fremgen AM, et al. A national cancer data base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer. 1998;83:2638-48. 22) Tickoo SK, Pittas AG, Adler M, et al. Bone metastases from thyroid carcinoma: a histopathologic study with clinical correlates. Arch Pathol Lab Med. 2000;124:1440-7. 23) Huang GT, Sheu JC, Yang PM, et al. Ultrasound-guided cutting biopsy for the diagnosis of hepatocellular carcinoma—a study based on 420 patients. J Hepatol. 1996;25:334-8. 11) Shah DH, Samuel AM. Metastasis to the liver in well-differentiated carcinoma of the thyroid. Thyroid. 1996;6:607-11. 16) 高橋 保，植田庄介，三谷美湖ほか．術後19年目に穿刺吸引細胞診で肝転移が発見された甲状腺癌の1例．日本臨床細胞学会雑誌．2004;43:272-5. 4) Sanders LE, Cady B. Differentiated thyroid cancer reexamination of risk groups and outcome of treatment. Arch Surg.1998;133:419-25. 17) Kelessis NG, Prassas EP, Dascalopoulou DV, et al. Unusual Metastatic Spread of Follicular Thyroid Carcinoma: Report of a Case. Surg Today. 2005;35:300-3. 26) Winston CB, Schwartz LH, Fong Y, et al. Hepatocellular carcinoma: MR imaging findings in cirrhotic livers and noncirrhotic livers. Radiology. 1999;210:75-9. 21) Massin JP, Savoie JC, Garnier H, et al. Pulmonary metastases in differentiated thyroid carcinoma. Study of 58 cases with implications for the primary tumor treatment. Cancer. 1984;53:982-92. 8) Wood WJ Jr, Singletary SE, Hickey RC. Current results of treatment for distant metastatic well-differentiated thyroid carcinoma. Arch Surg. 1989;124:1374-7. 18) Kouso H, Ikegami T, Ezaki T, et al. Liver metastasis from thyroid carcinoma 32 years after resection of the primary tumor: report of a case. Surg Today. 2005;35:480-2. 1) Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297-306. 27) Hussain SM, Semelka RC, Mitchell DG. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am. 2002;10:31-52. 20) Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375-81. 13) Tur GE, Asanuma Y, Sato T, et al. Resection of Metastatic Thyroid Carcinomas to the liver and the Kidney: Repot of a Case. Surg Today. 1994;24:844-8. 14) Graves WM, Zukerberg B, Walace K, et al. Isolated liver metastases from follicular thyroid cancer. Clin Nucl Med. 1996;21:147-8. 7) Zettinig G, Fueger BJ, Passler C, et al. Long-term follow-up of patients with bone metastases from differentiated thyroid carcinoma—surgery or conventional therapy? Clin Endocrinol (Oxf). 2002;56:377-82. 6) Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892-9. 15) Kondo T, Katoh R, Omata K, et al. Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid. Pathol Int. 2000;50:509-13. 5) Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174:474-6. 9) Schlumberger M, Challenton C, De Vathaire F, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996;37:598-605. 10) Bernier MO, Leenhardt L, Hoang C, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2001;86:1568-73. |
| References_xml | – reference: 6) Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892-9. – reference: 22) Tickoo SK, Pittas AG, Adler M, et al. Bone metastases from thyroid carcinoma: a histopathologic study with clinical correlates. Arch Pathol Lab Med. 2000;124:1440-7. – reference: 21) Massin JP, Savoie JC, Garnier H, et al. Pulmonary metastases in differentiated thyroid carcinoma. Study of 58 cases with implications for the primary tumor treatment. Cancer. 1984;53:982-92. – reference: 2) Hundahl SA, Fleming ID, Fremgen AM, et al. A national cancer data base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer. 1998;83:2638-48. – reference: 11) Shah DH, Samuel AM. Metastasis to the liver in well-differentiated carcinoma of the thyroid. Thyroid. 1996;6:607-11. – reference: 5) Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174:474-6. – reference: 20) Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375-81. – reference: 23) Huang GT, Sheu JC, Yang PM, et al. Ultrasound-guided cutting biopsy for the diagnosis of hepatocellular carcinoma—a study based on 420 patients. J Hepatol. 1996;25:334-8. – reference: 16) 高橋 保，植田庄介，三谷美湖ほか．術後19年目に穿刺吸引細胞診で肝転移が発見された甲状腺癌の1例．日本臨床細胞学会雑誌．2004;43:272-5. – reference: 26) Winston CB, Schwartz LH, Fong Y, et al. Hepatocellular carcinoma: MR imaging findings in cirrhotic livers and noncirrhotic livers. Radiology. 1999;210:75-9. – reference: 27) Hussain SM, Semelka RC, Mitchell DG. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am. 2002;10:31-52. – reference: 17) Kelessis NG, Prassas EP, Dascalopoulou DV, et al. Unusual Metastatic Spread of Follicular Thyroid Carcinoma: Report of a Case. Surg Today. 2005;35:300-3. – reference: 15) Kondo T, Katoh R, Omata K, et al. Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid. Pathol Int. 2000;50:509-13. – reference: 24) Liu YW, Chen CL, Chen YS, et al. Needle tract implantation of hepatocellular carcinoma after fine needle biopsy. Dig Dis Sci. 2007;52:228-31. – reference: 9) Schlumberger M, Challenton C, De Vathaire F, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996;37:598-605. – reference: 18) Kouso H, Ikegami T, Ezaki T, et al. Liver metastasis from thyroid carcinoma 32 years after resection of the primary tumor: report of a case. Surg Today. 2005;35:480-2. – reference: 10) Bernier MO, Leenhardt L, Hoang C, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2001;86:1568-73. – reference: 13) Tur GE, Asanuma Y, Sato T, et al. Resection of Metastatic Thyroid Carcinomas to the liver and the Kidney: Repot of a Case. Surg Today. 1994;24:844-8. – reference: 4) Sanders LE, Cady B. Differentiated thyroid cancer reexamination of risk groups and outcome of treatment. Arch Surg.1998;133:419-25. – reference: 12) Ohwada S, Iino Y, Hosomura Y, et al. Solitary Metastasis from Papillary Thyroid carcinoma in Cirrhotic Liver with Hepatocellular Carcinoma. Jpn J Clin Oncol. 1993;23:309-12. – reference: 8) Wood WJ Jr, Singletary SE, Hickey RC. Current results of treatment for distant metastatic well-differentiated thyroid carcinoma. Arch Surg. 1989;124:1374-7. – reference: 25) Ichikawa T, Federle MP, Grazioli L, et al. Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases. Radiology. 1999;213:352-61. – reference: 7) Zettinig G, Fueger BJ, Passler C, et al. Long-term follow-up of patients with bone metastases from differentiated thyroid carcinoma—surgery or conventional therapy? Clin Endocrinol (Oxf). 2002;56:377-82. – reference: 14) Graves WM, Zukerberg B, Walace K, et al. Isolated liver metastases from follicular thyroid cancer. Clin Nucl Med. 1996;21:147-8. – reference: 1) Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297-306. – reference: 3) Sampson E, Brierley JD, Le LW, et al. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer. 2007;110:1451-6. – reference: 19) 中野基一郎，丹黒 章．甲状腺乳頭癌の肝・骨転移にI-131内用療法が奏功した1例．日本臨床外科学会雑誌．2007;68:1908-13. |
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| Snippet | 症例は56歳の女性で，肺癌検診精査中に肝腫瘍を指摘，当院を受診した．甲状腺乳頭癌に対し18年前に甲状腺右葉切除術を，腺腫様甲状腺腫に対し16年前に甲状腺全摘術を... |
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| Title | 単発性肝転移と多発性骨転移を来し肝細胞癌との鑑別が困難であった分化型甲状腺癌の1例 |
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