慢性C型肝炎の背景の下,肝原発悪性リンパ腫と肝細胞癌を発症し,剖検で4重癌と判明した一例

Abstract

This is a case report of a 74-year old female patient with simultaneous quadruple cancers diagnosed at autopsy. The patient had been suffering from chronic hepatitis C, diabetes mellitus and hypertension since the age of 40. During the follow-up period of chronic liver disease, malignant lymphoma (ML) of the liver was found at age 66, and hepatocellular carcinoma (HCC) at age 68. ML was treated with chemotherapy and HCC with radiofrequency ablation (RFA) therapy, but both tumos recurred. At age 74, the patient was readmitted to the hospital with complaints of abdominal fullness and lower leg edema and was hospitalized. Various image examinations revealed ascites and multiple lymph node swelling around the abdominal aorta and it was diagnosed as recurrent ML. She died 5 months after hospitalization with multiple organ failure. At autopsy, another two carcinomas in addition to recurrent ML and remnant of HCC, squamous cell carcinoma (SCC) of the lung and high grade intraepithelial neoplasia (SCC in situ) of the esophagus were found. Hepatic inflammation caused by chronic hepatitis type C virus infection was probably a cause of HCC and ML. Additionally, her alcohol intake and smoking might be a risk for the development of SCC in both lung and esophagus. Cases with quadruple cancers are rare but the number of cases with multiple cancers is increasmg nowadays along with elongation of life expectancy. Periodical health check-ups will be required for aged people to find and treat a cancer earlier and to spend a good life.