Intrahepatični holangiokarcinom sa fudroajantnim tokom

  • Snežana B Knežević Dom zdravlja Kraljevo
  • Biljana R Srećković Dom zdravlja Kraljevo
  • Jelena A Vulović Opšta bolnica Paraćin
  • Marijana C Jandrić-Kočić Zdravstveni centar Krupa na Uni, R Srpska

Sažetak


Uvod. Holangiokarcinom je maligni tumor poreklom duktalnog epitela. Deli se na intrahepatične, karcinome žučne kese i periferne holangiokarcinome. Prevalenca zavisi od regiona, etničke pripadnosti, pola i lokalizacije tumora. Najčešći simptomi su žutica, bol, mučnina, gubitak težine. Često se tumor otkrije u odmakloj fazi kada je dao lokalne i udaljene metastaze. Medijana preživljavanja kod pacijenata koji su u uznapredovaloj neresektabilnoj bolesti je 3,9 meseci.

Prikaz slučaja. Šezdesetogodišnja pacijentkinja se u januaru 2018. godine žali na bol u epigastrijumu, gubitak težine i mučninu. Objektivno pozitivan Murphy znak i uvećana jetra. Ehosonografski jetra je lobulirana, heterogena, steatozna. U desnom režnju hipoehogene promene prečnika 12 mm. U laboratoriji: alfa-fetoprotein (AFP) 13,0 ng/mL, karcinoembrionalni antigen (CEA) 7,25 ng/mL, karbohidrat antigen (CA) 19-9 56,7 U/ml, sedimentacija eritrocita 29, bilirubin 24,7 μmol/l, alanin aminotransferaza (ALT) 32 U/L, aspartat transaminaza (AST) 56 U/L, alkalna fosfataza 181 U/L, C-reaktivni protein 43,1 µg/mL, acidum urikum 561 µmol/L. Kompjuterizovana tomografija pokazala uvećanu, lobuliranu, nehomogenu jetru, izdvajaju se nehomogene, heterodenzne promena neoštrih kontura, dimenzija 98x90x80 i 8x16mm. Magnetna rezonanca to potvrđuje. Rendgen pluća prikazuje multiple metastaze. Biopsija jetre potvrđuje primarni malignitet žučnih puteva. Pacijentkinja palijativno lečena i egzitirala u martu, dva meseca od početka razvoja bolesti.

Zaključak. Prevencija holangiokarcinoma podrazumeva što ranije dijagnostikovanje obolelih u rizičnoj populaciji. Rana dijagnoza podrazumeva veće šanse za lečenje i nešto bolju prognozu.

Ključne reči. Holangiokarcinom, žutica, jetra, palijativna nega, bol.

Biografije autora

Snežana B Knežević, Dom zdravlja Kraljevo

Specijalista opšte medicine u Domu zdravlja Kraljevo, izabrani lekar, Koordinator za nasilje nad ženama u Domu zdravlja, član predsednistva SLD (Sekcija Opšte medicine). Prvi autor 10 radova objavljenih u časopisima indeksiranim na SCI listi i 22 usmena i poster saopštenja, objavljena u domaćim i međunarodnim zbornicima i suplementima. Član EGPRN i WONCA SIGFV (svetske specijalne interesne grupe prtiv nasilja nad ženama).

Biljana R Srećković, Dom zdravlja Kraljevo
specijalista opšte medicine
Jelena A Vulović, Opšta bolnica Paraćin
specijalista anestezije i reanimacije u OB Paraćin
Marijana C Jandrić-Kočić, Zdravstveni centar Krupa na Uni, R Srpska
specijalista porodične medicine

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Objavljeno
2020/10/25
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