고혈압이 동반되지 않은 원발성 간 악성 부신경절종 1례

A Case of Primary Hepatic Malignant Paraganglioma without Hypertension

  • 이희성 (성균관대학교 의과대학 외과학교실, 삼성서울병원) ;
  • 이형근 (성균관대학교 의과대학 외과학교실, 삼성서울병원) ;
  • 유동도 (성균관대학교 의과대학 외과학교실, 삼성서울병원) ;
  • 허진석 (성균관대학교 의과대학 외과학교실, 삼성서울병원) ;
  • 최성호 (성균관대학교 의과대학 외과학교실, 삼성서울병원) ;
  • 최동욱 (성균관대학교 의과대학 외과학교실, 삼성서울병원)
  • Lee, Heuy-Seong (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Hyung-Geun (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • You, Dong-Do (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Heo, Jin-Seok (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Seong-Ho (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Dong-Wook (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2009.03.25

초록

Paraganglioma is an unusual neoplasm that is embryologically derived from neural crest cells. The most common location of this neoplasm is the adrenal medulla, where these tumors are known as pheochromocytoma. It is extremely rare that paragangliomas occur in the liver. There are only 7 reports of primary hepatic paraganglioma. A 56-year-old man was referred to XX Medical Center. Hypertension was not found. He had suffered from jaundice, headache and weight loss for the 4 previous weeks, but hypertension was not present. The total bilirubin was 7.7 mg/dl and the CA19-9 level was 56.3 U/dl. The tumor was diagnosed as intrahepatic cholangiocarcinoma on the computed tomography image. After biliary drainage via endoscopic nasobiliary drainage, surgical exploration was carried out; right trisectionectomy with caudate lobectomy, portal vein resection and anastomosis were then done. The final pathological diagnosis was primary hepatic malignant paraganglioma of the intrahepatic duct. There has been no evidence of recurrence on the follow up CT images during the 24 month follow up period.

키워드

참고문헌

  1. Dennis L. Kasper EB, Anthony S. et al. Principles of internal medicine. 16 ed: McGrow-Hill, 2005:2148-2152.
  2. Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004;27:193-202. https://doi.org/10.1291/hypres.27.193
  3. Suzuki Y, Nakada T, Suzuki H, et al. Primary bladder pheochromocytoma without hypertension. Int Urol Nephrol 1993;25:153-158.
  4. Jaeck D, Paris F, Welsch M, et al. Primary hepatic pheochromocytoma: a second case. Surgery 1995;117:586-590. https://doi.org/10.1016/S0039-6060(05)80260-0
  5. Homma K, Hayashi K, Wakino S, et al. Primary malignant hepatic pheochromocytoma with negative adrenal scintigraphy. Hypertens Res 2006;29:551-554. https://doi.org/10.1291/hypres.29.551
  6. Goldstein RE, O'Neill JA, Jr., Holcomb GW, 3rd, et al. Clinical experience over 48 years with pheochromocytoma. Ann Surg 1999;229:755-764; discussion 764-756. https://doi.org/10.1097/00000658-199906000-00001
  7. Elder EE, Xu D, Hoog A, et al. KI-67 AND hTERT expression can aid in the distinction between malignant and benign pheochromocytoma and paraganglioma. Mod Pathol 2003;16:246-255. https://doi.org/10.1097/01.MP.0000056982.07160.E3
  8. Shah MJ, Karelia NH, Patel SM, Desai NS, Mehta HV, Singh S. Flow cytometric DNA analysis for determination of malignant potential in adrenal pheochromocytoma or paraganglioma: an Indian experience. Ann Surg Oncol 2003;10:426-431. https://doi.org/10.1245/ASO.2003.04.007
  9. Song GW, Lee SG, Lee YJ, et al. Analysis of Survival After Portal Vein Resection (PVR) In Combination With Hepatectomy For Hilar Cholangiocarcinoma: An Audit of 51 Cases. Korean J Hepatobiliary Pancreat Surg 2007;11:47-57.