liver carcinoid
Introduction
Introduction to liver carcinoid Hepatic carcinoid (hepatic carcinoid) is a carcinoid that originates in the liver. It is an extremely rare, slow-growing epithelial cell tumor with a malignant tendency. Only a few patients have clinical manifestations of carcinoids syndrome. . basic knowledge The proportion of illness: 0.0005%--0.0007% Susceptible people: no specific population Mode of infection: non-infectious Complications: bloating
Cause
Causes of liver carcinogenesis
(1) Causes of the disease
The cause of this disease is unknown and the development is slow.
(two) pathogenesis
Liver carcinoid has neuroendocrine properties and belongs to APUD (amine percursor uptake and decarboxylation) cell tumors, which can secrete a variety of peptides and biogenic amines, including serotonin, pancreatic polypeptide (PP), insulin, somatostatin, gastrin. , adrenocorticotropic hormone (ACTH), gonadotropin, prostaglandin, calcitonin, etc., of which gastrin, pancreatic polypeptide (PP) is the most common in liver carcinoid, is the main substance of carcinoid syndrome in a small number of patients basis.
The histological source of liver carcinoids is not yet clear, and it is generally believed that there are several possibilities:
1. Pancreatic tissue derived from ectopic.
2. Neuroectodermal cells and embryonic residues derived from the foregut, or original pluripotent stem cells.
3. From the original neuroendocrine plate.
4. Endocrine cell epithelium derived from metaplasia.
Liver carcinoid is usually located in the right lobe of the liver, mostly one to two nodules, a few of which are multiple nodules, 1 to 17 cm in diameter, and the cut surface is pinkish brown or grayish yellow. There is irregular area in the center of the tumor, and necrosis is rare. It is soft or firm, contains more cysts, and the tumor and liver parenchyma are clearly defined. The surrounding liver tissue usually has no cirrhosis. The tumor consists of uniform small polygonal or cuboid cells. The cell boundaries are clear, and the cells are arranged in an island shape and nested. Banded, cord-like or palisade-like structure, cells are separated by a soft fibrous matrix, immunohistochemical staining, silver staining, silver staining and chromatin staining are strongly positive; epithelial membrane antigen (EMA), chromaffin Protein A (CgA) and nerve-specific dilute alcoholase (NSE) were mostly positive. Electron microscopy showed electron dense particles in the cytoplasm, ranging from 100 to 200 nm. Liver carcinoids often had intrahepatic metastasis or local lymph node metastasis at an early stage. Remote transfer is rare.
Prevention
Liver cancer prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Liver carcinoid complications Complications
1. Some patients have loss of appetite, indigestion, bloating, nausea, vomiting, etc., a small number of patients with stomach, duodenal ulcer.
2. Late cases often have anorexia, weight loss, fatigue, and fever.
Symptom
Liver cancer symptoms Common symptoms Dull pain, lack of appetite, bloating, abdominal distension, anorexia, liver enlargement, indigestion, nausea and pain
Liver carcinoid onset is concealed, early tumors are very small, without any symptoms and signs, when the carcinoid grows to a certain extent, it can cause local symptoms (often caused by mechanical factors).
1. Local symptoms: pain in the right upper abdomen or liver area, the most common, intermittent or persistent, dull or painful.
2. Gastrointestinal symptoms: Some patients have loss of appetite, indigestion, abdominal distension, nausea, vomiting, etc. A small number of patients have stomach and duodenal ulcers, so they may have peptic ulcer symptoms, even hematemesis, black stools. .
3. Systemic symptoms: Although immunohistochemistry has confirmed that hepatic carcinoids have ectopic neuroendocrine products at the cellular level, due to their insufficient or qualitative defects, they often fail to activate the target organs and exert biological effects. Most liver carcinoids have no clinical manifestations of abnormal increase of neuroendocrine products. Only a few cases have carcinoid syndrome, Zhuo-Ai syndrome, ectopic ACTH syndrome, and refractory hypoglycemia.
4. Other symptoms: Late cases often have anorexia, weight loss, fatigue, fever and other symptoms.
5. Signs: Liver enlargement is the most common sign. The liver is hard and the surface and edges are irregular. It is often nodular. A few tumors are buried deep in the liver parenchyma. The liver surface is smooth, with or without obvious tenderness. .
Examine
Liver carcinoid examination
Blood
In a small number of patients, the serotonin level is increased to 0.5 ~ 3mg / L (normal value is 0.1 ~ 0.3 mg / L), recently reported by immunohistochemical biochemical methods to detect the activity and expression of tryptophan hydroxylase in serum and tissue, also Helps diagnose cancer.
2. Urine
A small number of patients daily excretion of 5-hydroxyindoleacetic acid (5-HIAA) greater than 40mg (normal value does not exceed 10mg per day), when the 5-HIAA discharge in urine is >30mg / d, add 1-nitroso-2 - Naphthol reagent, urine is purple to black, do not take certain drugs (such as thiazides and mandelic acid derivatives) or foods containing a large amount of tryptophan (such as pears, bananas) within 24 hours before the 5-HIAA test. Pineapple, tomato, eggplant, walnut, etc.) to avoid false negative or false positive results.
3. In the MRI examination, the T1 weighted image often appears as a low signal region, and the T2 weighted image often appears as a high signal region, in which there is a plate-like higher signal region.
4. The characteristic change of liver carcinoid imaging is that there are multiple small cysts in the mass, but it is not possible to distinguish primary or metastatic carcinoid from imaging.
5. The qualitative diagnosis of liver carcinoids usually relies on immunohistochemistry, and electron microscopy ultrastructural examination proves that tumor cells have carcinoid characteristics and are finally diagnosed.
Diagnosis
Diagnosis and diagnosis of liver carcinoid
The carcinoid of the gastrointestinal tract often has liver metastasis at an early stage, and some of them also have the performance of carcinoid syndrome. Therefore, in the diagnosis of liver carcinoid, the extensive and detailed examination should be carried out first, and some cases even need to go through long-term follow-up. Diagnosis and observation, in order to completely rule out the existence of carcinoids in other parts, in addition, liver carcinoids should be differentiated from hepatocellular carcinoma, the latter is different from the clinical development of liver carcinoid, the performance of no carcinoid syndrome, mostly in cirrhosis On the basis of this, most of the alpha-fetoprotein (AFP) is increased, and immunohistochemistry and electron microscopy examine the tumor-free characteristics of tumor cells.
