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DOI: 10.1055/a-2000-5778
Kontrastmittelsonografie eines fibrolamellären hepatozellulären Karzinoms
Contrast-Enhanced Ultrasound of Fibrolamellar Hepatocellular Carcinoma
Zusammenfassung
Wir berichten über einen 24-jährigen Patienten, der sich mit anhaltenden Oberbauchschmerzen, Übelkeit und Völlegefühl ohne Erbrechen seit 5 Monaten zur ambulanten endoskopischen Diagnostik vorstellte. Bei der körperlichen Untersuchung fiel eine Verhärtung im Epigastrium ohne Druckschmerzhaftigkeit auf. Endoskopisch zeigte sich lediglich eine Impression des Bulbus duodeni bei intakter Duodenalschleimhaut. Darüber hinaus lagen unauffällige Befunde in Gastroskopie und Ileokoloskopie vor. Abdomensonografisch zeigte sich im linken Leberlappen eine große inhomogene Raumforderung mit scharfer, unregelmäßiger Begrenzung. Der rechte Leberlappen wies eine komplett unauffällige Sonomorphologie auf, insbesondere keine Zeichen des Parenchymschadens oder einer Leberzirrhose. Entlang der oberen mesenterialen Gefäße stellten sich mehrere vergrößerte Lymphknoten mit Kontakt zum Bulbus duodeni dar. In der Kontrastmittelsonografie (CE-US) zeigte die Leberläsion das typische Perfusionsmuster eines hepatozellulären Karzinoms. Zur Klärung des malignitätsverdächtigen Befunds wurde eine sonografisch gesteuerte Stanzbiopsie durchgeführt. Die histopathologische Aufarbeitung ergab den Befund eines hepatozellulären Karzinoms vom fibrolamellären Subtyp.
Mit diesem Fallbericht möchten wir zeigen, dass das HCC vom fibrolamellären Subtyp, trotz einer starken kollagenreichen bindegewebigen Stromakomponente in der Histopathologie, ein HCC-typisches Perfusionsmuster in der KM-Sonografie aufweist.
Abstract
We present the case of a 24-year-old male patient, who was admitted for endoscopy due to sustained pain in the upper abdomen with nausea and postprandial fullness without vomiting for more than 5 months. In the physical examination, an epigastric induration was found. Endoscopy revealed an external impression of the proximal duodenum. Beyond that, normal findings could be ascertained in gastroscopy and ileo-colonoscopy. Abdominal ultrasound identified a large hypoechoic lesion in the left liver lobe with a sharp delineation. Along the upper mesenteric vessels, enlarged lymphnodes were visible with contact to the proximal duodenum. Contrast-enhanced ultrasound (CE-US) was conducted and revealed the typical perfusion pattern of hepatocellular carcinoma. For further assessment, an ultrasound-guided core-biopsy of the lesion was performed. The histopathological evaluations resulted in the diagnosis of a hepatocellular carcinoma of fibrolamellar subtype.
With the present case, we want to illustrate the perfusion pattern of a fibrolamellar hepatocellular carcinoma in contrast-enhanced ultrasound. Even though the tumor tissue is surrounded by lamellar bands of fibrosis with collagen-rich fibers, the perfusion pattern is consistent with the previously known appearance of HCC in CE-US.
Publication History
Received: 22 November 2022
Article published online:
10 January 2023
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