合并乙肝肝硬化的肝上皮样血管内皮瘤1例报道并文献复习  

Hepatic epithelioid hemangioendothelioma complicated with hepatitis B cirrhosis: a case report and literature review

作　　者：李祥泽 王先明 宋歌声 崔晶[4] 孙凯[2] 王皓晨 王天成 韩绍奇 田虎 LI Xiangze;WANG Xianming;SONG Gesheng;CUI Jing;SUN Kai;WANG Haochen;WANG Tiancheng;HAN Shaoqi;TIAN Hu(Department of General Surgery,Shandong Provincial Qianfoshan Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250014,Shandong,China;Department of General Surgery,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China;Department of Radiology,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China;Department of Pathology,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China)

机构地区：[1]山东大学齐鲁医学院,山东省千佛山医院,山东济南250014 [2]山东第一医科大学第一附属医院(山东省千佛山医院),山东济南250014 [3]山东第一医科大学第一附属医院(山东省千佛山医院)放射科,山东济南250014 [4]山东第一医科大学第一附属医院(山东省千佛山医院)病理科,山东济南250014

出　　处：《山东大学学报（医学版）》2022年第11期89-95,共7页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2019MH116)

摘　　要：目的 分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床特点及影像学特征,从而提高对此病的认识,减少误诊,进一步指导临床诊疗。方法 收集并分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床资料,检索相关病例报道并进行文献复习。结果 患者,51岁,男性,因“体检中发现肝脏孤立占位性病变3 d余”入院,查体未见特殊异常。肿瘤标志物未见明显异常。肝脏MRI:平扫不具有特征性,扩散加权成像(DWI)和表观扩散系数(ADC)提示病变边缘部分弥散受限,中央区弥散不受限,提示合并坏死;增强扫描与CT类似,也是呈周边不均匀强化,并有向内填充的趋势,延迟期开始廓清。术后病理证实为肝上皮样血管内皮瘤。结论 在临床诊疗过程中,遇到肝脏实性占位性病变、影像学没有典型肝细胞癌、胆管细胞癌及肝血管瘤等常见病表现时,尤其是影像学提示典型的“包膜回缩征”“靶征”或“棒棒糖征”时,应考虑到本病可能。Objective To analyze the clinical and imaging characteristics of a patient with hepatic epithelioid hemangioendothelioma misdiagnosed preoperatively as hepatocellular carcinoma complicated with hepatitis B cirrhosis, so as to improve the understanding of this disease, reduce misdiagnosis and guide clinical diagnosis and treatment. Methods The clinical data of the patient were collected and analyzed, relevant case reports were retrieved and literature review was reviewed. Results The patient, a 51-year-old male, was admitted due to “isolated liver space-occupying lesions found in physical examination for more than 3 days”, and no other special abnormalities were obsevred. There were no obvious abnormalities in tumor markers. MRI of liver showed that plain scan was not characteristic. DWI and ADC suggested limited diffusion at the edge of the lesion, and unrestricted diffusion at the central area, suggesting combined necrosis. Enhanced scanning showed similar results, presenting uneven peripheral enhancement, which tended to invade inwards and clear during the delay period. Postoperative pathology confirmed hepatic epithelioid hemangioendothelioma. Conclusion In clinical diagnosis and treatment, the possibility of liver solid space-occupying lesions should be considered when there are no typical manifestations of common diseases such as hepatocellular carcinoma, cholangiocarcinoma and hepatic hemangioma, especially when imaging suggests typical “capsule retraction sign”, “target sign” or “lollipop sign”.

关 键 词：肝上皮样血管内皮瘤 乙肝肝硬化 影像学表现 鉴别诊断 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学] R575.2