摘要
目的分析肝脏炎性肌纤维母细胞瘤(IMT)的多层螺旋CT表现,并与病理相对照,以提高对该病的认识。方法回顾性分析经手术和病理证实的7例肝脏IMT,其中男5例,女2例,年龄26～59岁,平均年龄41岁。临床表现为右上腹不适或疼痛4例,发热2例,体检发现1例。术前分别经CT平扫及增强多期扫描,复习影像表现并与病理相对照。结果 7例病灶均为单发,其中位于肝右前叶3例,右后叶2例,肝左内叶2例。病灶大小不一,从2.2cm×1.7cm～5.6cm×5.2cm不等,形态多呈圆形或类圆形,5例边界欠清,2例边界清晰。CT平扫7例病灶均表现为低密度,增强扫描强化方式不等:①环形强化(3例):即动脉期病灶无明显强化,门脉期扫描病灶中央无强化,其边缘出现薄环/厚环形强化影,同时周边肝实质出现高密度强化带;②结节样强化伴中心坏死(3例):即动脉期病灶结节样轻度强化,邻近肝组织轻度强化;门静脉期病灶继续强化,中心更低密度区无强化;③分隔状强化(1例):即增强后动脉期无明显强化,门脉期、延迟期病灶逐渐呈分隔状强化,分隔之间可出现结节状或斑点状轻度强化区。3例病灶伴随肝内胆管不同程度扩张。病理特征:病灶均由大片增生的纤维结缔组织构成,主要由层列杂乱的纤维母细胞、肌纤维母细胞以及多量以浆细胞、淋巴细胞为主的炎细胞混合组成,中性粒细胞少见,7例病灶均可见凝固性坏死;肝索结构无明显异常,肝细胞轻度水样变性,细胞无明显异型性。免疫组化:Vimentin(++～+++)5例;SMA(++)4例;CD68(++)3例;CD34、CK均(-)。结论肝脏IMT是一种少见的肿瘤,多层螺旋CT检查能为其提供准确的解剖部位,在定性诊断方面有一定的特征性,最后确诊有赖于组织病理学及免疫组化检查。
Objective To study the multi-slice spiral CT（MSCT） imaging and pathological features of inflammatory myofibroblastic tumor （IMT） of liver. Methods 7 patients with IMT of liver proven by surgery and pathology underwent multi-slice spiral CT examination. The images were reviewed retrospectively and correlated with pathological manifestation. Results Among 7 cases, they were all single mass （5 in right lobe of liver, 2 in left lobe）. The diameters of masses were different （from 1.7-5.6 cm） and 5 cases had ill-defined margin. Although all lesions were hypodense on the precontrast CT scan, they showed variable patterns of contrast enhancement. 3 cases showed ring-shaped enhancement, which means that on the arterial phase and portal venous phase scan, non-enhancement or light-enhancement were observed in the central lesions, and ring-shaped enhancement in the peripheral portion of the masses; moreover, liver parenchyma surrounding the masses showed hyperdense （enhancement）. 3 cases showed nodular enhancement in the mass with central necrosis, which means that on the arterial phase the mass showed nodular enhancement, and further enhancement on the portal venous phase and delayed phase scan with central non-enhancement. 1 case showed separate-like enhancement, which means that on the arterial phase, non-enhancement or light-enhancement were observed, and separate-like en- hancement in the mass on portal venous or delayed phase scan. Microscopically, the tumors were mainly composed of spindle shaped fibrous cells and inflammatory cells （mainly plasma cell and lymphocyte）. Hepatocytes had no manifest heteromorphism. Immunohistoehemieally, SMA was positive in 4 cases, and Vimentin was positive in 5 cases, and CD68 was positive in 3 cases. Conclusion MSCT provides accurate anatomic location and helpful information for the clinical diagnosis of IMT of liver, and the definite diagnosis relies on pathological and immunohistochemical study.
出处
《医学影像学杂志》
2013年第6期909-912,共4页
Journal of Medical Imaging
关键词
肝肿瘤
肌组织
体层摄影术
X线计算机
病理
Liver neoplasms
Muscle tissue
Tomography, X-ray computed
Pathology
