肝内胆管癌伴骨、扁桃体转移一例及文献复习

A Case Report and Literature Review of Intrahepatic Cholangiocarcinoma with Bone and Tonsillar Metastases

摘要: 本文报告了一例肝内胆管癌(Intrahepatic Cholangiocarcinoma, ICC)患者出现骨转移和罕见扁桃体转移的病例。ICC是原发性肝癌的一种，起源于肝内二级胆管至肝内最小胆管分支的恶性肿瘤，具有高度侵袭性和转移性，常见转移部位包括肝内、肺、骨等。骨骼是肝癌转移的第三大常见部位，发生骨转移后2年生存率低于5%。本病例患者在确诊时已存在多处骨转移，治疗过程中出现双下肺微小结节及扁桃体转移。免疫组化及基因检测结果支持肝内胆管癌转移的诊断，患者接受了综合抗肿瘤治疗，包括化疗、免疫联合靶向治疗、放疗和对症支持治疗。最终，患者因全身多发转移、呼吸衰竭等并发症死亡。本病例强调了ICC的高侵袭性和多样的转移路径，提示临床医生在诊治过程中需考虑罕见转移部位，并加强多学科综合治疗策略的应用。

Abstract: This case report presents a patient with intrahepatic cholangiocarcinoma (ICC) who developed bone metastases and rare tonsillar metastasis. ICC, a type of primary liver cancer, originates from the secondary intrahepatic bile ducts to the smallest branches of the intrahepatic bile ducts and is characterized by high invasiveness and metastatic potential. Common metastatic sites include the liver, lungs, and bones, with the skeleton being the third most common site of liver cancer metastasis. The 2-year survival rate for patients with bone metastases is less than 5%. At diagnosis, the patient had multiple bone metastases and later developed small nodules in both lower lungs and tonsillar metastasis during treatment. Immunohistochemistry and genetic testing supported the diagnosis of ICC metastasis. The patient underwent comprehensive antitumor therapy, including chemotherapy, immunotherapy combined with targeted therapy, radiotherapy, and supportive care. Ultimately, the patient succumbed to complications such as widespread metastasis and respiratory failure. This case underscores the high invasiveness and diverse metastatic pathways of ICC, highlighting the need for clinicians to consider rare metastatic sites and to employ multidisciplinary treatment strategies.