摘要
目的 分析肝细胞腺瘤 (LCA)临床病理特点及需进行的鉴别诊断。方法 光镜下观察6例LCA的组织学形态。结果 本组 3例病人为女性 ,3例为男性 ,平均发病年龄为 32岁。 4例病人有右上腹不适、食欲不振、恶心、呕吐等症状 ,1例无症状 ,查体时偶然发现 ,1例合并肝紫斑病 ,肝破裂出血。本组 5例肿瘤位于右叶 ,1例位于左叶。肉眼上 ,肿瘤为质软、边界清楚的肿块 ,颜色略浅于周围肝组织 ,中心可见出血 ,肿瘤的最大径约为 3～ 15cm ,平均为 8cm。镜下肿瘤有如下特点 :1.多边形、境界清楚的瘤细胞与正常肝细胞相似 ,只是瘤细胞体积略增大 ,胞浆稍淡染。 2 .瘤细胞核圆形 ,大小较一致 ,核分裂像少见。 3.瘤细胞呈梁索状排列 ,厚度一般为 1～ 3层细胞。 4 .瘤内富于薄壁血窦和血管 ,瘤体周围常见厚壁动脉。 5 .肿瘤内无中央静脉、汇管区、小胆管结构及血管浸润现象。 6 .肿瘤可以有或无包膜 ,瘤外肝组织常受压萎缩。本组 6例病人术后随访至今均无复发。结论 LCA作为肝脏结节性病变的一种 ,需要与非肿瘤性灶状结节状增生 (FNH)和高分化肝细胞癌 (HCC)鉴别。
Objective To study the clinicopathological features of hepatocellular adenoma(LCA) and propose the differential diagnosis. Methods 6 LCA were observed by microscope. Results Three patients were femal and three were male with median age of 32 years. Four patients presented with pain in the right upper part of abdomen, anorexia, nausea and discomfort. Asymptomatic tumors of one patients were detected during routine explorations. One case coexist with peliosis hepatis and the patient experienced abrupt hepatic rupture and hemorrhage. Five tumors of our study were located in the right lobe of liver, one in the left. Macroscopically, the tumors appeared as soft, sharply circumscribed masses, usually lighter in color than the adjacent liver and with central hemorrage. The largest diameter of the tumors was 3-15 cm with median 8 cm. Microscopically, the tumors had characteristics as follows: 1.With sharp demarcation the cuboidal neoplastic cells resembled normal hepatocyts, just be larger and paler than hepatocytes. 2. The nucleis of the neoplastic cells were round and quite uniform in size with rare mitoses. 3. The neoplastic cells organized in sheets and cords, which were arranged in one to three cell thick plates. 4. The tumors were highly vascular with multiple thin walled sinusoids. A number of thick wall arteries were displaced around the surface of the tumors. 5. There was a absence of portal radicles, bile duct radicles without vascular invasion. 6. The tumors were or not encapsulated by on membrane with surrounding liver compressed. All the six patients survived operation and have done well since. Conclusion As one of hepatocellular nodular lesions LCA should be differentiated from focal nodular hyperplasia (FMH) and well diferentiated hepatocellular carcinoma(HCC).
出处
《中华肝胆外科杂志》
CAS
CSCD
2003年第3期142-146,共5页
Chinese Journal of Hepatobiliary Surgery
