造影超音波検査が有用であった肝原発神経内分泌腫瘍の 1 例

DOI: 10.3179/jjmu. JJMU.A.40
◇ CASE REPORT ◇ 造影超音波検査が有用であった肝原発神経内分泌腫瘍の 1 例
坂江遥1
門野潤3
玉井努1
東美智代4
宇都浩文1
井本浩3
室町香織1
梛野正人2
大西容雅1
井戸章雄1
抄　録
症例は 40 歳，女性．皮膚の紅斑を主訴に皮膚科を受診し，鑑別として皮膚筋炎が考えられ，悪性疾患の精査目的
に施行した腹部造影 CT 検査にて，肝 S 4 / 8 に動脈相で辺縁部から濃染し，平衡相で軽度 wash out される径 32
mm の腫瘤を認めた．腹部超音波検査 B モードでは，腫瘤のほとんどは境界明瞭な高エコーを呈し，内部の一部
に嚢胞状の低エコー域を認めた．腹部造影超音波検査では，腫瘍は 14 秒後から染影されはじめ，38 秒後に全体が
均一に濃染された．門脈相では均一で肝実質とほぼ等エコーであった．嚢胞状の部位は染影しなかった．後血管相
の advanced dynamic ﬂow で明瞭な defect を呈した．肝腫瘍生検の病理診断では，肝原発神経内分泌腫瘍（primary
hepatic neuroendocrine tumor: PHNET）が考えられたため，経皮経肝的門脈塞栓術を施行後に肝右葉 3 区域と尾状
葉切除術を施行した．肝腫瘍は免疫組織学的に，chromogranin A と synaptophysin が陽性で，MIB-I index は 1. 4％
であった．肝外に原発巣を認めなかったことから，肝原発神経内分泌腫瘍 Grade 1 と診断した．PHNET は稀な疾
患であり，造影超音波検査で評価した報告例は少なく，文献的考察を踏まえて報告する．
A case of primary hepatic neuroendocrine tumor in which contrast-enhanced ultrasound
was useful
Haruka SAKAE1, Tsutomu TAMAI, SJSUM1, Hirofumi UTO1, Kaori MUROMACHI1, Hiroka ONISHI1,
Jun KADONO3, Michiyo HIGASHI4, Yutaka IMOTO3, Masato NAGINO2, Akio IDO1
Abstract
A 40-year-old woman presenting with erythema was admitted to dermatology, where a mass 30 mm in diameter was
detected on abdominal computed tomography（CT）at segment 4 / 8 of the liver. Abdominal ultrasonography（US）
showed a hyperechoic mass with cystic change. Contrast-enhanced US revealed homogeneous hyperenhancement in the
arterial phase, but consisting of a non-enhanced area with a cystic lesion, and hypoechoic in the post-vascular phase
around normal liver parenchyma, with a defect was seen in the Kupffer phase. These ﬁndings were not speciﬁc for any
tumor, so we performed a percutaneous tumor biopsy, and diagnosed primary hepatic neuroendocrine tumor（PHNET）.
We performed percutaneous transportal embolization before hepatectomy（right trisectionectomy and caudate
lobectomy）. Immunohistochemically, the tumor cells were positive for the neuroendocrine markers（chromogranin A,
synaptophysin）and the Ki-67 index was 1. 4％. No primary lesion was found, leading to a classiﬁcation of primary
hepatic neuroendocrine tumor（PHNET）grade 1 and over. PHNET is rare and has a poor prognosis. We report a case of
PHNET with a review of the literature.
Keywords
primary hepatic neuroendocrine tumor（PHNET）, contrast-enhanced ultrasonography（CEUS）
鹿児島大学大学院医歯学総合研究科消化器疾患・生活習慣病学，3同心臓血管・消化器外科学，4同腫瘍学講座病理学，2名古屋大学大学
院腫瘍外科
1
Department of Digestive and Life-style Disease, 3Cardiovascular and Gastroenterological Surgery, 4Department of Pathology, Kagoshima
University Graduate School of Medical and Dental Sciences, 8︲35︲1 Sakuragaoka, Kagoshima, 890︲8544, Japan, 2Division of Oncology,
Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466︲8560, Japan
Received on March 7, 2015; Revision accepted on June 15, 2015 J-STAGE. Advanced published. date: August 28, 2015
1
Jpn J Med Ultrasonics

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