術前診断に苦慮した肝血管筋脂肪腫に対し腹腔鏡下肝部分切除術を施行した1例

Laparoscopic partial hepatectomy for hepatic angiomyolipoma that caused preoperative diagnostic difficulty

◆要旨：患者は40歳代，女性．健康診断で肝腫瘍を指摘され当院に紹介となり，術前検査で肝S2表面近くに径16mm大の腫瘍を認め，hepatocellular carcinomaやangiomyolipoma（以下，AML）が鑑別疾患に挙がったが確定診断には至らず，診断および治療目的に腹腔鏡下肝部分切除術を施行した．病理組織学的所見では淡明な胞体から成る類上皮細胞が腫瘍の大半を占めHMB-45染色とSMA染色が陽性となり，AMLと最終診断された．良悪性の鑑別が画像診断にて困難な小さな肝腫瘍に対して肝表に近い悪性腫瘍であった場合，生検では播種を起こす危険性もあり，腹腔鏡下で腫瘍を切除すれば侵襲が小さく，播種のリスクもなく有用な診断を兼ねた治療であると考えられたので報告する．

　The patient was a woman in her forties whose liver mass was detected by a medical check up. The tumor was located in segment 2 of the liver. Hepatocellular carcinoma （HCC） or hepatic angiomyolipoma （AML） was suspected by computed tomography and magnetic resonance imaging. If the tumor were HCC, there is a risk of peritoneal seeding after percutaneous needle biopsy. Therefore, we performed laparoscopic partial hepatectomy for the liver tumor. Immunohistochemical studies with antibodies for HMB-45 and smooth muscle actin were positive. The liver tumor was finally diagnosed as hepatic AML by histopathological examinations. It seems that laparoscopic hepatectomies are useful for selected patients with small liver tumor which is located at the surface of the hepatic parenchyma.