Kendal YALÇIN, Remzi BEŞTAŞ, Feyzullah UÇMAK, Mustafa YAKUT

Fibrolameller hepatosellüler kanser ve gebelik ilişkisi: Olgu sunumu

Fibrolameller hepatosellüler kanser, hepatosellüler kanserin nadir görülen bir varyantıdır. Altta yatan sirotik zeminin bulunmaması, farklı klinik tablo ve nispeten daha iyi seyir ile hepatosellüler kanserden ayrılmaktadır. Fibrolameller hepatosellüler kanserin gebelikle birlikteliği veya ilişkisi ile ilgili sınırlı bilgi mevcuttur. Bu olgu sunumunda, kliniğimize karın ağrısı ve kilo kaybı şikayetleri ile başvuran ve yakın zamanda gebelik öyküsü olan 30 yaşında bir kadın hasta tartışılmıştır. Hastamızda gebeliğinin altıncı haftasında vajinal kanaması başlamış ve yapılan medikal tedaviye rağmen kanaması kontrol altına alınamayan hastanın gebeliği sonlandırılmış. Yaklaşık bir ay sonra kliniğimize başvuran hastanın, yapılan fizik muayenesinde hepatomegali dışında pozitif bulgu saptanmadı. Laboratuar incelemelerinde, hepatit B ve C virüs infeksiyonuna ait viral markırlar negatif idi. Belirgin serum LDH yüksekliği ve hafif düzeyde aminotransferaz yüksekliği dışında diğer biyokimyasal bulgular ve alfa feto protein düzeyleri normal sınırlarda idi. Hastanın batın tomografisinde karaciğerde büyüme ve sağ lob posteriyorda 8x9 cm boyutlarında kitle mevcuttu. Yapılan karaciğer biyopsi bulguları fibrolameller hepatosellüler kanser ile uyumlu idi. Tekrarlanan tomografik incelemede kitlede hızlı büyüme, sol lobda da kitle saptanması ve bölgesel lenf nodu metastazı olması nedeni ile hasta inoperabl kabul edilerek kemoterapi başlanması düşünüldü. Ancak hasta kemoterapiyi kabul etmeyince palyatif tedavi uygulandı ve takibe alındı. Sonuç olarak, bu vaka ile gebe bir kadında karaciğerde kitle ve/veya vajinal kanama saptandığında fibrolameller hepatosellüler kanser tanısının da göz önünde bulundurulması gerektiği, fibrolameller hepatosellüler kanserinin gebelik seyri üzerine olumsuz etkilerinin olabileceği ve gebelikte fibrolameller hepatosellüler kanserin hızlı bir seyir izleyebileceği vurgulanmıştır.

Anahtar Kelimeler:

Karaciğer tümörleri, fibrolameller hepatosellüler karsinom, gebelik

Relationship of fibrolamellar hepatocellular carcinoma and pregnancy: A case report

Fibrolamellar hepatocellular carcinoma is a rare and distinct histological variant of hepatocellular cancer. Fibrolamellar hepatocellular carcinoma differs from hepatocellular cancer with a non-cirrhotic background, a favorable clinical presentation and a better prognosis. As a rare tumor of the liver, there is scarce data on the relationship between pregnancy and fibrolamellar carcinoma. In this case report, we present a 30-year-old woman who admitted to our department with complaints of abdominal pain, weight loss and a previous history of pregnancy. The patient had a history of medical abortus due to uncontrollable vaginal bleeding in the 6th week of pregnancy. A month later, physical examination showed liver enlargement without any abnormalities in the initial investigation. Virological markers of hepatitis B and C infections were found to be negative. Biochemical parameters and alpha fetoprotein were all in normal range except for substantial elevation of serum lactate dehydrogenase and mildly elevated levels of aminotransferases. Abdominal tomography revealed liver enlargement with a mass measuring approximately 8x9 cm in the right lobe. Histopathological findings of the liver specimen were compatible with fibrolamellar hepatocellular carcinoma. The patient was accepted to be in advanced stage according to the rapid progression of the tumor and lymph node metastasis. She was considered as inoperable and only palliative treatment could be instituted due to the patient's unwillingness. In conclusion, fibrolamellar hepatocellular carcinoma should be considered when a liver mass with or without vaginal bleeding is detected in a pregnant patient. Fibrolamellar hepatocellular carcinoma may have adverse effects on the pregnancy outcome and may have a rapid course in pregnancy.

Keywords:

Liver neoplasms, fibrolamellar hepatocellular carcinoma, pregnancy,

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