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肝切除手術治療巨大功能性嗜鉻細胞瘤合併肝臟侵犯:案例報告 陳聖賢 許士超 許家豪 陳德鴻 楊宏仁 鄭隆賓
中國醫藥大學附設醫院 外科部 消化外科
Hepatectomy for A HugeFunctional Pheochromocytoma With Liver Invasion : A Case Report
S.H. Chen, S.C. Hsu, C.H. Hsu, T.H. Chen, H.R. Yang, L.B. Jeng
Division of Gastroenterology Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
Pheochromocytoma is an endocrine tumor. Distant metastasis occurs in approximately 10% of cases and is diagnosed as malignant pheochromocytoma . Liver is the main site of metastasis and hepatectomy was reported as a therapeutic option for reduction of tumor mass in patients with liver metastases. We would like to present a case of huge functional pheochromocytoma with liver invasion who accepted hepatectomy and recovered well.
A 40 years-old female had history of hypertension and tachycardia under medication in local clinic for 6 years. Under the impression of secondary hypertension, further examinations were done and then high urine vanillylmandelic acid (VMA) level was found. Abdominal CT revealed a huge(12.6cm) tumor in right suprarenal area with liver invasion. Her liver function was normal and no other evidence of metastasis was found. Hence we performed right lobectomy and right adrenectomy in this May.
The patient stood uneventful right lobectomy and right adrenectomy well and discharged smoothly 7 days after operation. Urine VMA level decreased (73.89 12.87) after operation and down to normal range when following in OPD. Hypertension and tachycardia were also remission and she doesn’t need any medication. Pathology revealed pheochromocytoma with invasion to liver parenchyma and has potentially malignant biologic behavior, but the resection margin is free of tumor involvement. There was no recurrent or metastasis during follow-up in post operative 4th month.
This is a rare case of pheochromocytoma with liver invasion and hepatectomy is a successful therapy for this patient. Unstable blood pressure during operation and anesthesia was reported as a fatal risk in surgery of functional pheochromocytoma. Carefully mobilize the liver and avoid direct stimulation of the tumor during operation may contribute to avoid thismorbidity.Although this surgery is technically demanding, we conclude that hepatectomy is a feasible option in patients of functional pheochromocytoma with liver invasion.
