Intrahepatični holangiokarcinom sa fudroajantnim tokom
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.
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