摘要
目的观察纤维板层型肝癌（ＦＬＨＣＣ）的影像学表现的病理基础。方法经病理证实ＦＬＨＣＣ９例，男５例、女４例，年龄１６岁～４５岁，均无肝炎及肝硬化病史。做超声波（ＵＳ）检查９例，ＣＴ８例，ＭＲＩ６例，血管造影７例。结果①病理检查：７例切除标本中，单发分叶状肿块６例，多个结节相融合１例，质硬，界限清楚，有假包膜５例，剖面中部可见灰白色近似放射状致密瘢痕灶，４例肿块内有大小不一囊状液化坏死区。②ＵＳ表现：肿块呈高回声３例，内有条状低回声瘢痕结构：呈混杂回声６例，３例肿瘤内有大小不等的囊性无回声区。ＤｏｐｐｌｅｒＵＳ示肿块实性部分血供丰富。③ＣＴ表现：８例平扫病灶低于肝实质密度，５例肿块内有粗大放射状瘢痕结构，３例有囊状低密度区，肿瘤内有点状钙化４例。增强扫描７例均呈明显强化，内有囊状及星条状低密度区，大体标本显示前者为囊状坏死，后者为致密胶原瘢痕。均无肝硬化及脾脏增大表现。④ＭＲＩ表现：６例平扫Ｔ１加权像病变低于肝实质信号，５例内有星条状更低信号区。Ｔ２加权像肿瘤信号较高而不均匀，其中Ｔ１加权像显示的条状低信号区、于Ｔ２加权像上亦呈低信号，病理证实为胶原瘢痕。增强扫描４例均呈明显强化，瘢痕区无强化。⑤肝动脉造影?
Purpose To observe the imaging findings of fibrolamellar hepatocellular carcinoma(FL HCC) and identify its correlative pathology.Methods Imaging studies in 9 patients with pathologically proved FL HCC were reviewed.There were five men and four women,age ranging from 16 to 45 years.The cirrhosis or Hepatitis was not found in patient's history recordings,and all serum α fetoprotein levels were normal.Imaging studies included ultrasonography(US) in 9 patients,CT in 8,MRI in 6,and angiography in 7.Results ①Gross specimens were available in seven patients.There was a single lobulated mass in six patients,and a multilobulated mass in 1 patient.The tumors were well demarcated and firm.On cross sections,the tumor had a pseodo capsule with a central gray and white radiated like scar in five patients.Cystic necrosis was found in four specimens.②On US,the echogenicity of the tumor was hyperechoic relative to normal liver in 3 patients,and mixed hypoechoic in 6 patients.Cyst like regions with variant size were found within the masses in 3 patients.doppler US revealed that the solid portion of the tumors were hypervascular.③Nonenhanced CT scan demonstrated all lesions were hypodense to the liver.Five of the lesions had a central lower density radiating pattern region which were conformed as densely packed collagenous scar by pathologic examination,three presented with cystic necrosis.Punctate calcification was seen in 4 of 8 patients.Marked contrast enhancement of the masses were seen on the early phase in 7 patients who underwent enhanced CT,and the central scarlike structures remained unenhancement.Liver cirrhosis and splenomegaly were not found in this series.④On MRI,the tumor was hypointense relative to the liver parenchyma on T 1 weighted spin echo image and inhomogeneuos hyperintense on T 2 weighted image.5 of the six patients had a central radiate like structures which were hypointense on both T 1 weighted and T 2 weighted image.On contrast enhanced MRI,four patients had obviously enhancement,and the central scar did not enhance on both early and delayed enhancement.⑤On hepatic arterial angiography,a globular hypervascular mass with radiating pattern neovascularity was found in 3 of the seven patients.Peripheral nodular tumor stain,which was similar to that of hemangioma,was seen in 2 patients.A hypovascular mass with displacement of the adjacent vessels was found in 2 cases.No arterial shunting to hepatic or portal vein was identified.Conclusion The imaging features,including a large hepatic mass with entral scar and calcification,or with obviously cysitic like necrosis,and without associated with cirrhosis,might be of FL HCC suggestive. [
出处
《中国医学影像技术》
CSCD
北大核心
1999年第1期56-59,共4页
Chinese Journal of Medical Imaging Technology
关键词
肝肿瘤
超声波诊断
CT
NMR
成像
血管造影术
Liver neoplasms Ultrasonography Tomography,X ray computed Magnetic resonance imaging Angiography
