| Objective:Adenosquamous carcinoma is rare in primary malignant tumor of liver.Most of the reports in foreign and domestic countries are based on case reports.In this paper,a case in Huzhou Hospital of Zhejiang University was analyzed,and the related literatures about primary hepatic adenosquamous carcinoma were analyzed retrospectively,in order to increase the clinician's understanding of the disease and reduce the rate of misdiagnosis and mistreatment.Methods:This paper reports a case of primary hepatic adenosquamous carcinoma treated in Huzhou Hospital of Zhejiang University in 2017.Through searching the Pubmed foreign language database,and the Chinese database such as Cqvip periodical database,Wanfang database and China National Knowledge Intrnet(CNKI)to summarize the relevant cases of primary hepatic adenosquamous carcinoma diagnosed by histopathology and provide relevant clinical data for analysis since the establishment of the above databases.Finally,the demographic data,clinical symptoms and signs,laboratory examination,as well as imaging examination,histopathological features,antidiastole,therapy and prognosis of the disease were analyzed and discussed.Results:A 54-year-old male came to our hospital because of upper abdominal pain for one month.Out-patient examination abdominal ultrasound indicated that there was occupying lesions in the left liver.For more detailed diagnosis as well as treatment,he is advised to be hospitalized.Right upper abdominal tenderness was suggested by physical examination after admission.Imaging diagnosis considered cholangiocarcinoma with bile duct dilatation.After exclusion of operative taboo,hepatectomy was performed.Postoperative pathology showed that there were both highly differentiated squamous cell carcinoma and mucinous adenocarcinoma.After excluding malignant tumors from other primary sites outside the liver,he was diagnosed as primary adenosquamous carcinoma of the liver.The patient received combined radiotherapy and chemotherapy after surgery,but died of tumor progression 9 months after operation.A total of 36 literatures at home and abroad met the inclusion exclusion criteria,plus this case included a total of 49 cases.There were 34 males and 15 females with a male-to-female ratio of 2.27.The median age of onset was 63 years old.Most of the patients had abdominal pain as the first symptom,fever,hypopnea,weight loss and fatigue were common symptoms.The positive signs of physical examination were mainly abdominal palpation and abdominal tenderness.In laboratory examination,liver function was abnormal,carcinoembryonic antigen squamous cell carcinoma associated antigen and carbohydrate antigen 19-9 could be increased.All the patients were negative for alpha-fetoprotein except one case.The disease is usually not associated with viral hepatitis B and C.Preoperative imaging examination has low specificity and is often misdiagnosed as liver abscess,primary hepatocellular carcinoma and cholangiocarcinoma.Preoperative percutaneous liver biopsy was performed in 12 cases,and only 2 cases could be correctly diagnosed,The diagnosis depends mainly on postoperative histopathological examination.Surgery is the main treatment with a median recurrence time of 3 months and a median overall survival time of 5.5 months.Conclusion:Primary adenosquamous carcinoma of the liver is a rare clinical disease,most of which is seen in elderly men.Abdominal pain is the main clinical manifestation,followed by fever,anorexia,emaciation,etc.The imaging features are atypical,difficult to diagnose before operation and easy to be misdiagnosed.Postoperative histopathology is the gold standard for diagnosis.Surgical resection is the first choice of treatment,but recurrence and metastasis can occur within a short period of time after operation,and the prognosis is poor. |
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