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Liver transplantation (LT) is currently one of the best available strategies for treating multiple hepatocellular carcinoma (HCC) and decompensated liver cirrhosis. However, patients often undergo HCC... recurrence after LT, with most HCC recurrences detected at 1-2 years. CD133 was the first identified member of the prominin family of pentaspan membrane proteins and is a marker of hepatic stem cells. Here, we report a unique case of seven repeated recurrences of HCC in the lungs after LT, with all HCC recurrences resected curatively by a thoracoscopic approach. Pathological examination revealed moderately differentiated HCC identical to that in the original histology of the liver tumor. Interestingly, no CD133 immunoreactivity was observed in cancerous lesions of the primary HCC and the 1st to 2nd recurrences, as indicated by immunohistochemistry. However, CD133 was strongly stained in the cancerous lesions from the 3rd to 7th recurrences. The patient survived and had no recurrence after 9 years of the initial living donor LT. In conclusion, we investigated an evocative case of seven repeated recurrences of HCC in the lungs to elucidate the significance of circulating CD133-positive hepatic stem cells. This case illustrates the need for further research to clarify the mutual effect of CD133-positive hepatic stem cells for the development of new therapeutic strategies.
肝移植は非代償性肝硬変を合併した肝細胞癌の症例に対する治療戦略として確立している.しかしながら, 肝移植後に肝細胞癌の再発をみとめることも希ではなく, そのほとんどが移植後1〜2年以内におこるとされている. また近年, CD133は現在肝の幹細胞のマーカーとして注目されている. われわれは肝移植後に7回の肺転移を繰り返し, 胸腔鏡下に切除可能であった症例を経験した. 原発巣, 初回, 2回目の再発まで癌部におけるCD133は陰性であったのにも関わらず, 3回目以降の再発部にはCD133の発現は強陽性であった. 患者は肝移植後9年の現在再発なく生存中である. 本症例は肝移植後7回の再発を繰り返した. 流血中のCD133陽性幹細胞の肝癌再発における臨床的な意義を示唆する貴重な症例と考え報告する.続きを見る
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