乙状结肠癌肝转移并发肝内胆管癌一例

A Case Report of Sigmoid Colon Cancer with Liver Metastasis Complicated by Intrahepatic Cholangiocarcinoma

摘要: 大约一半的结直肠癌患者发生肝转移，而结直肠癌肝转移并发肝内胆管癌极为罕见。我们在此报道一例49岁男性，3年前外院检查发现肝脏肿物。术前根据患者辅助检查，诊断为结肠中分化腺癌，而肝内病变考虑为结肠癌肝转移。我们为其进行了手术治疗，结直肠肝转移并发肝内胆管癌诊断通过术后病理学证实。针对该例患者，我们采用mFOLFOX6联合贝伐珠单抗的治疗策略，近期取得良好效果，肿瘤标志物和影像学未见复发迹象，目前无病生存期 > 11个月，这种治疗方式可为类似患者提供一定的参考意义。同时当我们在结直肠癌患者的肝脏中检测到实性病变时应怀疑肝内胆管癌的可能性。我们在诊断转移性肿瘤时，也应该将多原发性肿瘤的可能性作为鉴别诊断，并进行系统综合治疗。

Abstract: Approximately half of patients with colorectal cancer develop liver metastases. However, the coexistence of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma is extremely rare. We report a case of a 49-year-old male patient with a liver mass detected at an outside hospital three years ago. Preoperative evaluation led to a diagnosis of moderately differentiated adenocarcinoma of the colon, and the hepatic lesion was initially considered liver metastasis from colorectal cancer. The patient underwent surgical treatment, and the diagnosis of colorectal cancer liver metastasis complicated by intrahepatic cholangiocarcinoma was confirmed by postoperative pathology. The patient was treated with mFOLFOX6 combined with bevacizumab, achieving a favorable short-term response. No tumor recurrence was observed on tumor marker testing or imaging. The disease-free survival exceeds 11 months. This therapeutic strategy may provide a reference for similar cases. When a solid hepatic lesion is detected in patients with colorectal cancer, the possibility of intrahepatic cholangiocarcinoma should be considered. In the diagnosis of metastatic tumors, multiple primary malignancies should also be included in the differential diagnosis, and comprehensive systemic treatment should be administered.