以假性肝硬化起病的乳腺癌肝转移一例报告并文献复习  

Pseudocirrhosis as the main manifestation for hepatic metastasis from breast cancer:a case report and literature review

作　　者：鲁俊锋[1] 马丽娜[1] 陈新月[1] Lu Junfeng;Ma Lina;Chen Xinyue(Department of Hepatology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病综合科,100069

出　　处：《北京医学》2020年第6期496-499,共4页Beijing Medical Journal

摘　　要：目的总结乳腺癌肝转移患者形成假性肝硬化的临床特点,提高对本病的认识。方法总结2019年1月首都医科大学附属北京佑安医院收治的1例以假性肝硬化起病的乳腺癌肝转移病例的临床资料,并进行文献复习。结果患者发病前1年诊断乳腺原位癌,行左乳切除手术,术后长期口服托瑞米芬。本次因腹胀、尿黄入院,实验室检查提示肝功能、凝血指标异常,嗜肝病毒血清学标志物阴性,自身抗体谱阴性;CT、MRI均提示结节性肝硬化、腹水、脾大、侧支循环形成;胃镜检查提示食管静脉重度曲张;经颈静脉肝穿活检病理提示乳腺癌肝转移。给予护肝、曲妥珠单抗治疗,病情曾有一过性好转,后并发上消化道出血,病情逐渐进展至肝衰竭。患者发病4个月后死亡。结论乳腺癌肝转移患者可以假性肝硬化为主要临床表现,病情进展快,死亡率高,早期识别和治疗或可改善预后。Objective To explore the clinical characteristics of pseudocirrhosis in breast cancer patients with liver metastasis and improve the understanding of this disease.Methods One case of pseudocirrhosis in breast cancer with liver metastasis was reported.The clinical data and relevant literatures were reviewed.Results The patients were diagnosed with breast cancer in situ one year before the onset of the disease and left mastectomy was performed.After the operation,toremifene was taken.The patient’s main complaint was abdominal distention and urine yellow.Laboratory examination showed abnormal liver function and coagulation,negative serological markers of hepatophilus viruses,and negative autoantibodies.CT and MRI showed nodular cirrhosis with ascites,splenomegaly and collateral circulation.Gastroscopy showed severe esophageal varices.Pathological findings from transjugular liver biopsy showed liver metastasis of breast cancer.Hepatoprotective drugs and trastuzumab were given.The patient’s condition had been improved for a while and then gradually progressed to liver failure after upper gastrointestinal hemorrhage.The patient died four months after the onset of the disease.Conclusions Patients with liver metastasis from breast cancer may have pseudocirrhosis as the main clinical manifestation with rapid progress and high mortality.Early recognition and treatment may improve prognosis.

关 键 词：假性肝硬化 乳腺癌 肝转移 

分 类 号：R737.9[医药卫生—肿瘤]