右副腎腫瘍と鑑別困難であった肝外発育型肝細胞癌の1例

Abstract

高血圧, 右側腹部痛を主訴とした61歳女で, CT及びエコーグラムで腎上部塊を認めた.尿分析から高カテコラミン血症が疑われ, 右副腎腫瘍と診断され, 褐色細胞腫が疑われた.手術し, 肝右葉下面より突出した腫瘍が正常な右副腎を圧迫しているのを認め, 5×4.5×6.5 cm, 75 gの腫瘍を摘除した.組織学的に肝細胞癌, Edmondoson grade 3と診断した.術後10ヵ月現在再発も転移も認められていない

We report a rare case of extrahepatic growing hepatocellular carcinoma which was clinically diagnosed as right adrenal tumor. A 61-year-old woman was admitted for further examination of right flank pain and hypertension. Abdominal computed tomographic scan and echogram revealed a suprarenal mass. Hypercatecholaminemia was suspected from urinary analysis. Preoperative diagnosis was right adrenal tumor; suspected pheochromocytoma. On operation, we found the tumor was pedunculated from right lobe of liver and compressing normal right adrenal gland. Its clinical diagnosis was hepatocellular carcinoma. Ten months after operation she is still alive. We discuss the difficulty of differential diagnosis between extrahepatic growing hepatocellular carcinoma and adrenal tumor.