Melena kao prvi znak metastatskog angiosarkoma jetre

Aleksandra Sokic-Milutinovic; Ljubisa Toncev; Tijana Glisic; Vera Matovic; Marjan Micev; Srdjan Djuranovic; Miodrag Krstic

doi:10.2298/VSP160923073S

Aleksandra Sokic-Milutinovic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
Ljubisa Toncev Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
Tijana Glisic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
Vera Matovic Emergency Center, Clinical center of Serbia, Belgrade, Serbia
Marjan Micev Department of Pathology, Clinical center of Serbia, Belgrade,Serbia
Srdjan Djuranovic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia
Miodrag Krstic Clinic for Gastroenterology and hepatology, Clinical centre of Serbia, Belgrade,Serbia

DOI: https://doi.org/10.2298/VSP160923073S

Keywords: hemangiosarkom, jetra, neoplazme, melena, dijagnostičke tehnike i procedure, dijagnoza, diferencijalna, lečenje, palijativno

Abstract

Apstrakt

Uvod. Angiosarkomi su maligni tumori vaskularnog endotela koji mogu nastati na različitim lokacijama. Iako primarni angiosarkomi jetre čine samo 1.8% primarnih tumora jetre to su najčešći maligni mezenhimalni tumori jetre. Prikazujemo slučaj primarnog angiosarkoma jetre sa melenom kao neobičnom inicijalnom manifestacijom ovog vrlo retkog tumora. Prikaz slučaja. Bolesnik star 44 godine upućen je na našu Kliniku zbog melene koja je perzistirala nakon ponavljanih argon plazma koagulacija krvarećih lezija tokom ezofagogastroduodenoskopije u regionalnoj bolnici. Ultrazvuk i multislajsna kompjuterska tomografija (MSCT) abdomena ukazali su na uvećanu jetru sa fokalnom lezijom levog lobusa promera 6 cm i multiplim satelitskim lezijama u oba lobusa, uvećanu slezinu, kao i ekstremno proširenu i dugačku umbilikalnu venu. Double balloon enteroskopijom i endoskopskom video kapsulom uočene su brojne krvareće vaskularne lezije u tankom crevu. Patohistološki pregled i imunohistohemijska bojenja biopsija lezija iz tankog creva ukazala su na maligni mezenhimski tumor vaskularnog/endotelnog porekla. Zaključeno je da se kod bolesnika radi o metastatkom angiosarkomu sa najverovatnijim primarnim ishodištem u jetri i metastazama u tankom crevu, što je uzrokovalo melenu, i kičmenom stubu, što je uzrokovalo bol u leđima. Zaključak. Retki uzroci melene uključuju krvarenje iz primarnog ili metastatskog hemangiosarkoma lokalizovanog u gastrointestinalnom traktu, posebno u tankom crevu.

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