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BN nam, 33 tuổi Địa chỉ: Phú Hòa Phú Yên 2017 BN ói ra máu, khám tại Medic Hòa Hảo CĐ VIÊM GAN B – VIÊM DẠ DÀY BN uống hêt thuốc theo toa, không tái khám, điều trị thuốc nam. Cách vài tháng BN đau bụng quanh rốn, đi cầu phân sống, ngay sau ăn, đi nhiều lần 1 ngày, làm BN sụt 3kg trong vòng 2 tháng. Khám pk Phú Yên CĐ VIÊM ĐẠI TRÀNG, uống thuốc ko đỡ. khám tại Hòa Hảo
HCC with malignant portal vein thrombosis in young adults A Case report BS T R Ầ N T HỊ T HA N H N G A K HO A S I Ê U Â M BN nam, 33 tuổi Địa chỉ: Phú Hịa - Phú n 2017 BN ói máu, khám Medic Hòa Hảo CĐ VIÊM GAN B – VIÊM DẠ DÀY Bệnh Án BN uống hêt thuốc theo toa, không tái khám, điều trị thuốc nam Cách vài tháng BN đau bụng quanh rốn, cầu phân sống, sau ăn, nhiều lần ngày, làm BN sụt 3kg vòng tháng Khám pk Phú Yên CĐ VIÊM ĐẠI TRÀNG, uống thuốc ko đỡ khám Hòa Hảo Tiền Bản thân : nhiễm HBV , bỏ điều trị năm, uống thuốc nam, khám CK tiêu hóa nhà BN có uống rượu, bỏ rượu tháng Gia đình: có chị gái bị nhiễm HBV, điều trị Phú Yên BÀN LUẬN HCC người trẻ Infiltrative/ diffuse HCC Tiên lượng HCC người trẻ 11 patients with HCC who were between 13 and 40 years of age Eight patients (72.7%) had abdominal pain directly caused by advanced tumors Most patients had highly advanced HCC; patients (81.8%) had tumors larger than 10cm in diameter, and all had portal invasion Among patients who underwent hepatectomy survived more than year, and patient has been alive 71 months without disease The other patients, whose tumors could not be resected, died within months of diagnosis HCC in young adults are rarely detected early because of their relatively good liver function despite their higher positive rate for HBs antigen Therefore, early screening for cancer is particularly important in young adults who are HBs antigen-positive 20 patients (16 males) with HCC who were younger than aged 40 years Fifteen of 20 patients were positive for hepatitis B surface antigen (HBsAg) Because most of the patients did not receive periodic follow-up, this disease often was discovered at an advanced stage, usually after the appearance of some symptoms Although intensive treatment was performed for such young patients, the survival was nevertheless poor Most patients died from this cancer within year Young patients with HCC tended to have a poor prognosis because of advanced stage of HCC, despite a well-preserved liver function and aggressive treatment Infiltrative HCC accounts for 7%–20% of HCC cases the spread of minute tumor nodules throughout large regions of the liver Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis an ill-defined area of markedly heterogeneous echotexture and thus is often indistinguishable from cirrhosis the study by Yu et al 50% of infutrative HCC were not detected at US Ultrasonography malignant portal vein thrombosis (PVT) suspected when the absence of normal blood flow and the presence of a hypoechoic thrombus expanding the vessel The presence of pulsatile flow in a PVT at spectral Doppler examination, specific (95%), sensitive (62%) sign of malignant PVT US can be used to guide liver biopsy to obtain specimens to confirm HCC Advantages and Pitfalls of Various Modalities for Imaging of Infiltrative HCC BÀI HỌC RÚT RA HCC người trẻ dù tỉ lệ thấp có, khơng chủ quan khám siêu âm gan BN trẻ Huyêt khối tĩnh mạch cửa dấu hiệu BN HCC dạng thâm nhiễm Dùng linear probe nghi ngờ HCC / mô gan xơ, không đồng TÀI LIỆU THAM KHẢO Aramaki M, Kawano K, Sasaki A, Ohno T, Tahara K, Kai S, Iwashita Y, Kitano S Hepatocellular carcinoma in young adults Hepatogastroenterology 2005 Nov-Dec;52(66):1795-7 Arich R Reynolds, Alessandro Furlan , David T Fetzer1, Eizaburo Sasatomi, Amir A Borhani, Matthew T Heller, Mitchell E Tublin Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know Radiographic Vol 35 No Published Mar 12 2015 https://doi.org/10.1148/rg.352140114 Çolaklar A, Altınbaş NK Infiltrative non-mass-like hepatocellular carcinoma initially presenting with isolated malignant portal vein thrombosis: A case report and review of the literature J Ultrason 2020;20(80):e55-e60 doi: 10.15557/JoU.2020.0009 Epub 2020 Mar 31 PMID: 32320167; PMCID: PMC7266071 Demirjian A, Peng P, Geschwind JF, Cosgrove D, Schutz J, Kamel IR, Pawlik TM Infiltrating hepatocellular carcinoma: seeing the tree through the forest J Gastrointest Surg 2011 Nov;15(11):2089-97 doi: 10.1007/s11605-011-1614-7 Epub 2011 Jul PMID: 21725699; PMCID: PMC3580771 Diagnostic and prognostic role of alpha-fetoprotein in hepatocellular carcinoma: both or neither?Farinati F, Marino D, De Giorgio M, Baldan A, Cantarini M, Cursaro C, Rapaccini G, Del Poggio P, Di Nolfo MA, Benvegnù L, Zoli M, Borzio F, Bernardi M, Trevisani F Am J Gastroenterol 2006 Mar Evidence for an association between the aetiology of cirrhosis and pattern of hepatocellular carcinoma development.Benvegnù L, Noventa F, Bernardinello E, Pontisso P, Gatta A, Alberti A Gut 2001 Jan; 48(1):110-5 Farhi DC, Shikes RH, Murari PJ, Silverberg SG Hepatocellular carcinoma in young people Cancer 1983 Oct 15;52(8):1516-25 doi: 10.1002/1097-0142(19831015)52:83.0.co;2-n PMID: 6311397 Hernández-Castillo E, Mondragón-Sánchez R, Garduno-Lopez AL, Gómez-Gómez E, Ruiz-Molina JM, ate-Oca LF, Bernal-Maldonado R Hepatocellular carcinoma in the youth A comparative analysis with hepatocellular carcinoma in adulthood Hepatogastroenterology 2005 May-Jun;52(63):903-7 PMID: 15966229 Li L, Xu L, Wen T, et al Poor Prognoses of Young Hepatocellular Carcinoma Patients with Microvascular Invasion: A Propensity Score Matching Cohort Study Gastroenterol Res Pract 2020;2020:4691425 Published 2020 Feb 14 doi:10.1155/2020/4691425 Poddar N, Avezbakiyev B, He Z, Jiang M, Gohari A, Wang JCJ Hepatocellular carcinoma presenting as an incidental isolated malignant portal vein thrombosis Gastrointest Cancer 2012 Sep; 43(3):486-9 Ren J, Tong YM, Cui RX, Wang Z, Li QL, Liu W, Qu K, Zhang JY, Liu C, Wan Y Comparison of survival between adolescent and young adult vs older patients with hepatocellular carcinoma World J Gastrointest Oncol 2020; 12(12): 1394-1406 Yamazaki, Yuichi & Kakizaki, Satoru & Sohara, Naondo & Sato, Ken & Takagi, Hitoshi & Arai, Hirotaka & Abe, Takehiko & Katakai, Kenji & Kojima, Akira & Matsuzaki, Yutaka & Mori, Msatomo (2007) Hepatocellular Carcinoma in Young Adults: The Clinical Characteristics, Prognosis, and Findings of a Patient Survival Analysis Digestive diseases and sciences 52 1103-7 10.1007/s10620-0069578-2