肝細胞癌の経過中に肝原発腺扁平上皮癌を合併した１例

症例は74歳男性｡慢性Ｃ型肝炎にて当院外来通院中であった｡肝細胞癌を指摘され1998年7月腹部血管造影, 経皮エタノール注入療法施行した｡以後当院外来加療中であったが, 腹部超音波上肝Ｓ５に低エコー域を認め, 1999年10月27日精査加療目的で入院となった｡入院 後肝Ｓ６にも低エコー域を認めた｡超音波ガイド下経皮的針生検施行し, Ｓ５では中から低分化の腺癌に加え, 部分的に扁平上皮癌が認められ, 腺扁平上皮癌と診断された｡Ｓ６では中分化, 一部高分化の肝細胞癌を認めた｡転移性肝癌の可能性を考え全身検査を行なったが,他臓器に原発病巣は発見されず, 肝細胞癌に肝原発扁平上皮癌を合併したと考えた｡経皮的エタノール注入療法施行し12月28日退院となった｡その後も外来にて加療されていたが, 2000年３月肝Ｓ４を中心に再発し, ９月９日死亡した｡肝細胞癌に合併した肝原発腺扁平上皮癌は稀であり, 若干の文献的考察を加えて報告する｡

A rare case of primary adenosquamous carcinoma of the liver with hepatocellular carcinoma in a 74-year-old man is discussed. The patient had been treated for chronic hepatitis type C. He was diagnosed with hepatocellular carcinoma and abdominal angiography and percutaneous ethanol injection was performed in July 1998. After percutaneous ethanol injection , he consulted the doctor in our hospital regularly. Abdominal ultrasonography identified a hypoechoic mass in liver S5 and he was admitted to our hospital on October 27, 1999. After admission, on ultrasonography a hypoechoic mass was depicted in liver S6. A percutaneous liver biopsy was performed and the histopathological examination revealed adenosquamous carcinoma composed of moderately or poorly differenciated adenosquamous carcinoma and squamous cell carcinoma in S5 and moderately or well differenciated hepatocellular carcinoma in S6. He was diagnosed with primary adenosquamous carcinoma of the liver with hepatocellular carcinoma because further examinations showed no primary lesion in other organs. Percutaneous ethanol injection was performed and he was discharged on December 28. Ultrasonography revealed a hypoechoic nodule in S4 in March 2000 and he died on September 9, 2000.