肝细胞癌扁桃体转移：一例病例报告及文献综述。

文献信息

中文摘要

背景： 肝细胞癌（HCC）的扁桃体转移极为罕见。方法：我们报告一名84岁慢性乙型肝炎男性，表现为右叶HCC及门静脉癌栓。诊断三个月后，肝内转移接受经动脉化疗栓塞和仑伐替尼治疗。结果：23个月后，他出现血性痰；影像学和喉镜检查发现左侧扁桃体肿块，同时伴有肺部和肝脏进展。扁桃体切除术取得未分化癌病变。与原发性肿瘤相比，扁桃体转移灶丢失肝细胞特异性抗原（Hep Par-1）和精氨酸酶-1表达，Ki-67指数显著升高（80%），但保留Glypican-3和热休克蛋白70（HSP70）。结论：基于临床病史、实验室检查和病理免疫组化整合，倾向于诊断为转移性HCC。在HCC患者中，任何异常的头部和颈部病变都应怀疑转移；多标志物组合对诊断至关重要，因为精氨酸酶-1丢失并不能排除HCC。

英文摘要

Tonsillar metastasis from hepatocellular carcinoma (HCC) is extremely rare. We report an 84-year-old man with chronic hepatitis B who presented with a right-lobe HCC and portal vein tumor thrombosis. Three months after diagnosis, intrahepatic metastases were treated with transarterial chemoembolization and lenvatinib. Twenty-three months later, he developed blood-tinged sputum; imaging and laryngoscopy revealed a left tonsillar mass with concurrent pulmonary and hepatic progression. Tonsillectomy yielded an undifferentiated carcinoma lesion. Compared with the primary tumor, the tonsillar metastasis lost hepatocyte specific antigen (Hep Par-1) and Arginase-1 expression, showed a markedly elevated Ki-67 index (80%), but retained Glypican-3 and heat shock protein 70 (HSP70). A diagnosis of metastatic HCC was favored based on integration of clinical history, laboratory findings, and pathological immunohistochemistry. In HCC patients, any unusual head and neck lesion warrants suspicion of metastasis; a multi-marker panel is critical for diagnosis, as loss of Arginase-1 does not rule out HCC.