摘要
目的利用肝移植手术标本,探讨肝细胞肝癌(HCC)边缘部CT征象的组织病理学基础及其与HCC生物学行为的关系。方法经肝移植手术证实的HCC45例,术前全肝平扫后,分别于开始注射造影剂后25s、60s行全肝螺旋CT动、门脉双期扫描。观察新鲜手术标本后,常规HE染色和因子相关抗原(facter related antigen,F8RA)单克隆抗体免疫组化染色,观察肿瘤边缘部的CT表现及各种病理改变。结果1CT平扫病灶边缘清楚(无分叶或有分叶),病理上肿瘤多有包膜(完整或不完整);CT平扫边缘不清时,病理上肿瘤少见有包膜,浸润性生长多见;2动态增强后肿瘤边缘不清或呈高密度者,边缘多可见丰富的新生血管,肿瘤分化较低。而边缘呈低密度者,多可见肿瘤的包膜或假包膜形成,新生血管较少,分化程度较高;3有肝内子灶组,其肿瘤边缘微血管密度(microvessel density MVD)值要高于无肝内子灶组,而且当肿瘤边缘MVD>30时,发生肝内子灶的几率要高。结论1HCC边缘部的CT形态分类,能较好的反映肿瘤包膜的完整程度,有助于术前评估肿瘤的浸润程度和范围及评价癌细胞的分级;2CT动、门脉双期扫描,癌灶边缘强化特征可反映其组织病理学改变,并能在一定程度上预测其生物学行为和预后。
Objective To study the pathologic bases of the CT findings of the peripheral of the HCC lesions and the way affect the biologic behavior. Method Forty-five patients with HCC confirmed by liver transplantation were included. An unenhanced scanning covering the whole liver was done, and followed by arterial and portal venous phase scanning. The delay time was 25 sec land 60 sec after the injection of contrast media. After evaluation of the fresh samples and the stained slides with HE and the standard immunoperoxidase method using the monoclonal antibody of facter Ⅷ related antigen （F8RA） , the CT patterns of the peripheral of tumor and the pathological changes were studied. Results ① On CT scan, clear boundary （lobular or non-lobular） could reflect the capsule of tumor （integral or non-integral） on pathology. Blurred boundary often showed that few lesions had capsules and the growth pattern was invasive. ② After enhancement, the peripheral of HCC demonstrated as blurred or hyper-attenuation showed rich neovascular structure , low tumor differentiation and high metastasis rate. While the formation of pseudocapsule or capsule , poor neovascular structure,high tumor differentiation and low metastasis rate could be seen in the tumor with hypo-attennuation peripheral. ③ The microvessel density （MVD） was higher in the group with daughter foci in liver parenchyma. Moreover when MVD〉30 in the peripheral of the HCC lesions, the incidence rate of metastasis was high. Conclusion ① The integrity of tumor capsule could be well reflected by the CT patterns of the peripheral of HCC. The patterns were useful to estimate the extent of tumor invasion as well as grading of tumor cell. ② The peripheral enhancement features of HCC on multi-detector spiral CT dural-phase scanning could reflect the histopathologic characteristics and predict the biologic behavior and prognosis to a certain degree.
出处
《肝胆外科杂志》
2005年第4期265-268,共4页
Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
体层摄影术
X线计算机
病理学
Carcinoma, hepatocellular
Tomograghy, X-ray computed
Pathology
