Ekstenzija hepatocelularnog karcinoma u donju šuplju venu i desni atrij: prikaz slučaja

Autor: Morić, Nikolina, Mijandrušić-Sinčić, Brankica, Milić, Sandra, Fučkar Čupić, Dora, Matana Kaštelan, Zrinka, Miletić, Damir
Jazyk: chorvatština
Rok vydání: 2022
Předmět:
Zdroj: Medicina Fluminensis : Medicina Fluminensis
Volume 58
Issue 2
Medicina Fluminensis
ISSN: 1847-6864
1848-820X
DOI: 10.21860/medflum2022_275138
Popis: Cilj: Prikazati bolesnika s hepatocelularnim karcinomom koji je izravno invadirao desni atrij, a inicijalno se prezentirao bezbolnom žuticom i kardijalnom insuficijencijom. Prikaz slučaja: Na Zavod za gastroenterologiju zaprimljen je sedamdesetsedmogodišnji bolesnik zbog bezbolne žutice i kardijalne insuficijencije. U fizikalnom statusu uočeni su edemi obiju potkoljenica i natkoljenica te hepatomegalija. Laboratorijskom analizom utvrđene su povišene vrijednosti kreatinina u serumu, ukupnog bilirubina, jetrenih enzima te produženo protrombinsko vrijeme i aktivirano parcijalno tromboplastinsko vrijeme. Nativna snimka abdomena pokazala je uredan nalaz. U daljnjoj obradi učinjen je ultrazvuk abdomena na kojem je prikazana uvećana jetra, nepravilnije površine, difuzno hiperehogena, inhomogena, bez vidljivih fokalnih lezija uz proširenje intrahepatičnih žučnih vodova. Test na markere hepatitisa B i C bio je negativan. Zbog razjašnjavanja uzroka bilijarne opstrukcije indicirana je magnetska rezonancija abdomena i magnetnorezonantna kolangiopankreatografija (MRCP). Otkrivena je infiltrativna tumorska tvorba koja opsežno zahvaća žučne vodove, invadira donju šuplju venu i direktno prodire u desni atrij. Širokoiglenom biopsijom i patohistološkom analizom dijagnosticiran je hepatocelularni karcinom (HCC). Tijekom hospitalizacije ordinirana je kardijalna terapija, niskomolekularni heparin, supstitucija albumina i antibiotska terapija zbog infekcije bakterijom Clostridium difficile. Usprkos intenzivnom liječenju pacijent je preminuo s kliničkom slikom višeorganskog zatajenja. Zaključak: Izravna penetracija HCC-a u desni atrij rijedak je entitet. U bolesnika koji se prezentiraju bezbolnom žuticom uz negativan nalaz ultrazvuka, potrebno je proširiti slikovnu dijagnostiku na magnetsku rezonanciju i MRCP zbog superiornosti u procjeni bilijarnog stabla. Iako je žutica rijetka prva manifestacija hepatocelularnog karcinoma, ne treba isključiti taj entitet, posebice u bolesnika s jetrenom cirozom.
Aim: To report a case of a patient with hepatocellular carcinoma that directly invaded the right atrium, initially manifested with painless jaundice and cardiac insufficiency. Case report: A seventy-seven-year-old patient was admitted to the Department of Gastroenterology due to painless jaundice and cardiac insufficiency. Edema of both lower legs and thighs and hepatomegaly were observed in the physical status. Laboratory analysis revealed elevated serum creatinine, total bilirubin, liver enzymes and prolonged prothrombin time and activated partial thromboplastin time. Radiographic tomography showed no pathological finding. In further procedure, abdominal ultrasound was performed which revealed the enlarged liver with irregular surface, diffusely hyperechoic, inhomogeneous, without visible focal lesions with dilation of the intrahepatic bile ducts The test for hepatitis B and C markers were negative. To clarify the cause of biliary obstruction, abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) were indicated. An infiltrative tumor was detected that extensively affected the bile ducts, invaded the inferior vena cava, and penetrates directly into the right atrium. Hepatocellular carcinoma (HCC) was confirmed by core needle biopsy and histopathological examination. During hospitalization, cardiac therapy, low molecular weight heparin, albumin substitution, and antibiotic therapy for Clostridium difficile infection were prescribed. Despite the efforts and treatment, the patient passed away because of multiple organ failure. Conclusion: The extension of hepatocellular carcinoma per continuitatem into the right atrium is a rare entity. In the case of painless jaundice and negative ultrasound findings, it is necessary to extend the imaging diagnostics to magnetic resonance imaging and MRCP which is superior in the assessment of the biliary tree. Although jaundice is a rare manifestation of hepatocellular carcinoma, this entity should not be ruled out, especially in patients with liver cirrhosis.
Databáze: OpenAIRE
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