摘要
目的 探讨肝脏局灶性结节性增生（FNH）的临床和影像学特点.方法 收集2006年1月至2014年4月就诊的19例肝脏FNH患者.检测患者血AFP、ALT、AST、TBil水平.肝组织经常规HE染色后行病理检查,并行肝组织磷脂酰肌醇蛋白聚糖3（Gpc3）、CD34、细胞角蛋白19（CK19）的免疫组织化学染色检查.分析患者超声、CT、MRI检查的结果.结果 19例肝脏FNH患者中,男11例,女8例,中位年龄为32岁;2例有乙型肝炎肝硬化,2例有脂肪肝,1例有慢性乙型肝炎,其余14例无慢性肝病史.3例有腹痛症状,有腹泻或腹胀症状者各1例,其余14例无症状.结节由增生的肝细胞组成,病灶中央有星形瘢痕伴放射状纤维分隔,CK19阳性,CD34阳性,Gpc3阴性.患者血清AFP水平均正常,3例ALT和AST均升高,5例TBil升高.10例接受超声检查的患者中,发现低回声结节5例,高回声结节2例,多发低至高回声结节2例,未发现占位1例,均未被诊断为肝脏FNH.12例接受CT检查的患者中,发现低密度结节10例,等密度结节2例;增强扫描动脉期强化11例,其中静脉期或延迟期呈高密度5例,静脉期或延迟期呈等密度3例,静脉期或延迟期呈低密度3例;增强扫描动脉期无强化,静脉期或延迟期呈等密度1例;仅2例被诊断为肝脏FNH.9例接受MRI检查的患者中,平扫病灶表现为等T1信号1例,低信号6例,高信号2例;长T2信号8例,等T2信号1例,增强扫描动脉期明显强化8例,门静脉期持续强化,平衡期、延迟期强化减弱6例,环状强化2例,1例动脉期可见条状信号影无强化,平衡期见条状信号强化;增强扫描动脉期无强化1例,静脉期低信号,但中心呈点状强化;仅1例被诊断为肝脏FNH.肝穿刺活组织检查明确诊断后未接受治疗者9例,接受手术切除者7例,取活组织检查术中接受射频治疗者2例,肝活组织检查后接受经导管肝动脉化学治疗栓塞术（TACE）者1例.7例获随访,随访时间为1个月～3年,6例未复发或出现新发灶,1例出现新发灶.结论 大部分肝脏FNH患者无临床症状,单一CT、MRI检查的诊断价值有限,联合CT和MRI检查或可提高诊断率.
Objective To explore the clinical and imaging features of focal nodular hyperplasia （FNH） of the liver.Methods From January 2006 to April 2014,19 patients with FNH of the liver were collected.The serum levels of alpha fetoprotein （AFP）,alanine aminotransferase （ALT）,aspartate transaminase （AST） and total bilirubin （TBil） were examined.Liver tissues were underwent regular hematoxylin-eosin （HE） staining and pathological analysis.The expression of glypican-3 （Gpc3）,CD34 and cytokeratin 19 （CK19） in liver tissues was detected by immunohistochemistry.The results of ultrasound,computed tomography （CT） and magnetic resonance imaging （MRI） examination were analyzed.Results Among 19 patients with FNH of the liver （11 males and eight females,the median age was 32 years old）,there were two with hepatitis B liver cirrhosis,two with fatty liver disease,one with chronic hepatitis B and the remaining 14 without any chronic liver diseases.Three cases had abdominal pain,one case had diarrhea and one case had abdominal distension,the remaining 14 cases didn＆#39;t have any symptoms.Nodules were formed by proliferated hepatocytes,there were star shaped scar with radial fiber separator in the central of the lesions with positive CK19 and negative CD34 and Gpc3.The serum AFP level of patients was normal.Both ALT and AST increased in three patients.TBil increased in five patients.Among 10 patients received ultrasound examination,hypoechoic nodules were found in five cases,hyperechoic nodules in two cases,multi hypoechoic to hyperechoic nodules in two cases,and one case was found no nodule,none of them was diagnosed as FNH of the liver.Among 12 received CT examination patients,10 had low density nodules,two equal density nodules.Nodules of 11 patients had enhancement in arterial phase,five cases showed high density during portal phase or delay phase,three cases showed equal density during portal phase or delay phase,three cases showed low density during portal phase or delay phase,one case had no enhancement in arterial phase and showed equal density during portal phase or delay phase,only two cases were diagnosed as FNH of the liver.Among nine cases who received MRI examination,one case showed equal T1 signal,six cases had low signal,and two cases had high signal; eight cases had long echo T2 signal and one case had equal echo T2 signal; eight cases significantly enhanced during arterial phase,six cases continuously strengthened during portal phase and weakened during equilibrium phase and delay phase,two cases had cyclic strengthen,one case had strip signal without enhancement in arterial phase and strip signal enhanced in the equilibrium phase.One case did not strengthen during enhancement scan in the arterial phase and showed low signal in venous phase,however the central of the lesion showed punctate enhancement.Only one case was diagnosed as FNH of the liver.Nine patients were diagnosed with liver biopsy but without any treatment,seven patients received operation,two patients received radiofrequency treatment during biopsy,and one patient received transcatheter arterial chemoembolization （TACE） treatment.Seven cases were followed up,the follow-up time was one month to three years.New lesion was found in only one case.Conclusion Most FNH of the liver have no clinical symptoms.Combination of CT and MRI may increase the diagnostic rate.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2015年第2期95-98,共4页
Chinese Journal of Digestion
基金
北京市卫生系统高层次卫生技术人才培养计划（2011-2-19）
北京市首都发展专项基金（2014-1-192）
关键词
局灶性结节性增生
肿瘤
肝
计算机断层扫描
磁共振成像
Focal nodular hyperplasia
Neoplasms
Liver
Computed tomography
Magnetic resonance imaging
