肝癌肝移植术后新发肺腺癌1例报道

doi:10.3969/j.issn.1004-583X.2025.12.010

摘要/Abstract

摘要：

目的探讨肝癌肝移植术后患者新发肺腺癌的临床特点、诊断方法及治疗挑战，为临床此类特殊病例的诊疗提供参考。方法回顾性分析1例68岁肝癌肝移植术后新发肺腺癌患者的临床资料，包括病史、症状体征、诊断手段及治疗过程。结果患者经皮肺穿刺活检确诊肺腺癌，肺癌相关基因检测及程序性死亡配体-1表达均为阴性。化疗后患者出现严重肝转氨酶升高，被迫终止化疗。肺部肿瘤持续进展并引发呼吸衰竭，需无创呼吸机辅助通气。结论肝癌肝移植术后长期免疫抑制治疗可能增加新发恶性肿瘤风险，此类患者肺腺癌起病隐匿，缺乏典型临床表现，诊断依赖病理检查。化疗耐受性差是其治疗的主要难点，临床需结合患者移植术后基础状况制定个体化诊疗方案，在抗肿瘤治疗的同时重视器官功能保护。

关键词: 肝移植, 肺癌, 免疫制剂, 免疫逃逸

Abstract:

Objective To explore the clinical characteristics，diagnostic methods and treatment challenges of newly developed lung adenocarcinoma in liver cancerpatients after liver transplantation，thus providing references for the diagnosis and treatment of such special cases in clinical practice. Methods A retrospective analysis was conducted on the clinical data of a 68-year-old liver cancer patient with newly developed lung adenocarcinoma after liver transplantation，including medical history，symptoms and signs，diagnostic methods and treatment process. Results The patient was diagnosed with lung adenocarcinoma by percutaneous lung biopsy. Lung cancer-related genes and programmed death ligand-1 （PD-L1） were all negative. After chemotherapy，a severe increase in liver transaminase forced to the termination of chemotherapy. The lung tumor continued to progress，leading to respiratory failure that was required for non-invasive ventilator-assisted ventilation. Conclusion Long-term immunosuppressive therapy after liver transplantation for liver cancer may increase the risk of new malignant tumors. Lung adenocarcinoma in such patients has an insidious onset and lacks typical clinical manifestations，and the diagnosis relies on pathological examination. Poor tolerance to chemotherapy is the main difficulty in its treatment. Clinically，individualized diagnosis and treatment plans should be formulated based on the basic post-transplantation conditions. While undergoing anti-tumor treatment，attention should also be paid to the protection of organ functions.

Key words: liver transplantation, lung cancer, immunotherapeutic agents, immune escape

中图分类号:

R657.3

王园园, 赵志芳, 赵云霞, 何杨, 张晴. 肝癌肝移植术后新发肺腺癌1例报道[J]. 临床荟萃, 2025, 40(12): 1108-1112.

Wang Yuanyuan, Zhao Zhifang, Zhao Yunxia, He Yang, Zhang Qing. A case of newly developed lung adenocarcinoma following liver transplantation for hepatocellular carcinoma[J]. Clinical Focus, 2025, 40(12): 1108-1112.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.12.010

https://www.lchc.cn/CN/Y2025/V40/I12/1108

图/表 3

图1 患者入院后胸部CT表现 a~c.双肺多发结节伴空洞，右下肺较大结节；d.纵隔淋巴结增大；e.右下肺实性结节；f.俯卧位行经皮肺穿刺，选择右下肺较大结节

Fig.1 Chest CT manifestations of the patient on admission a-c. Multiple nodules with cavities in both lungs，and a larger nodule in the right lower lung； d. Enlarged mediastinal lymph nodes； e. Solid nodule in the right lower lung； f. Percutaneous lung puncture of a larger nodule in the right lower lung in the prone position

图2 肺穿刺活检病理结果：黏液腺癌（HE×200）

Fig.2 Pathological results of lung biopsy： Mucinous adenocarcinoma （H&E×200）

图3 患者出院后2个月胸部CT复查表现 a~c.双肺多发结节伴空洞增大，新发胸腔积液，右下肺肿块显著增大；d~f.对应肺窗，纵隔窗可见双肺实性肿块增多，增大，新发胸腔积液

Fig.3 Chest CT reexamination of the patient 2 months after discharge a-c. Multiple nodules with enlarged cavities in both lungs，new pleural effusion，and a significantly enlarged mass in the right lower lung； d-f. Increased and enlarged solid masses with new onset of pleural effusion in corresponsive lung window and mediastinal window of both lungs

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