肝血管平滑肌脂肪瘤的诊治  

Diagnosis and treatment of hepatic angioleiomyolipoma

作　　者：黄刚 马曾辰[2] 钦伦秀[2] 汤钊猷[2] 

机构地区：[1]武警广东总医院肿瘤外科,广州510507 [2]上海医科大学中山医院肝外科,200032

出　　处：《岭南现代临床外科》2002年第1期22-24,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的 研究肝血管平滑肌脂肪瘤(HALL)的影像学特征、病理学特点,探讨其诊断及治疗方法。方法 分析4例经手术及病理证实的HALL的影像学表现(B超、CT、MRI、^(99m)锝-吡哆醛-5-甲基色氨酸)及病理特点。结果 B超(US):肿瘤呈强回声光团2例,边界清楚3例,回声均匀2例,其中1例内呈网状结构。彩色多普勒超声示肿瘤血供丰富,阻力指数0.4～0.5。注射造影剂后肿瘤内血流增加。CT:肿瘤呈低密度影3例,均匀2例,界清3例,肿瘤内见软组织影2例,脂肪成分1例。增强扫描动脉期明显强化,门脉期及延迟期呈低密度影。MRI:肿瘤呈短T_1、长T_2信号,增强后明显强化,脂肪抑制后短T_1变成长T_1。^(99m)Tc-PMT示肿瘤呈放射性增强,5min相呈放射性缺损,延迟相未见放射性填充。肝血池相呈放射性填充。病理及免疫组化:肿瘤由脂肪、血管及平滑肌组成,黑色素瘤(克隆号:HMB-45)呈阳性。均行手术治疗。结论 HALL的影像特点变化较大,诊断困难。此病应尽早手术治疗。最后确诊依靠病理检查及免疫组化分析。Objective To study the feature of the imaging and histopathology of hepatic angioleiomyolipoma (HALL), and discuss it's diagnosis and surgical management. Methods The analysis of imaging manifestation and pathologic feature of 4 cases of HALL were confirmed by operation and histopathology. Results Ultrasonography revealed a hyperechoic mass in two cases, well - defined mass in three, and homogenous echoic mass in two. One of the four showed a network lesion. The hypervascular lesion were revealed by colour Doppler of ultrasonography. Resistant index was 0.4 - 0.5. On the plain CT, three of four were well - defined margin. Two showed homogeneous. One revealed fat com-ponant. Two presented the shadow of soft tissues inside the mass. After injected contrast medium, the lesions appeared wcll enhanced on the arterial phase and become gradually a shadow of lower density on the portal vein phase and postpone phase .Upon MRI examination, the lesion appeared short Tl ,long T2 imaging.The short Tl changed into long Tl after fat - suppression technique 99mTc - PMT;The tumor showed radioactive enhancement,5min phase showed a radioactive de-fect. No radioactive filling was found in the postpone phase. The hepatic blood pool phase revealed a radioactive filling. Histopathology and immuno histochemistry examination : the tumor was composed of three components that included blood vessel celis, smooth muscle celis and mature adipose tissue, and HMB - 45 was positive. The surgical treatment was done in all cases. Conclusion The diagnosis of HALL is very difficult because of it' s imaging feature had a more varia-tion. An operation should be performed for HALL as early as possible. According to the pathologic examination and immuno - histochemical analysis, the final diagnosis can be confirmed.

关 键 词：血管平滑肌脂肪瘤 肝脏 B超 CT MRI 病理学 肝切除 

分 类 号：R73[医药卫生—肿瘤]