误诊为肝细胞癌的病例分析(附五例报告)  

Analysis of cases misdiagnosed as hepatocellular carcinoma (report of 5 cases)

作　　者：欧阳墉[1] 马和平[1] 吴晓梅[1] 张学军[1] 张晓琴[1] 王琦朝 鲁孟 

机构地区：[1]内蒙古自治区医院介入放射科 病理科

出　　处：《中华放射学杂志》1997年第3期180-184,共5页Chinese Journal of Radiology

摘　　要：目的：提高肝细胞癌（ＨＣＣ）的诊断正确率。材料与方法：回顾性分析外科治疗前５例误诊为ＨＣＣ的临床、影像学和实验室检查以及正确诊断、治疗和随访结果等。结果：５例经病理学证实分别为肝细胞腺瘤、胆管囊腺瘤恶性变、孤立性肝转移腺癌、腹膜后恶性纤维组织细胞瘤和外生型胃神经鞘瘤。５例中３例因瘤体巨大富血而未能作手术切除，４例术后曾接受介入治疗或（和）化疗。３例良性肿瘤（包括伴有恶性变１例）３年后仍存活。结论：术前如能辨认肝细胞腺瘤和胆管囊腺瘤ＣＴ和血管造影的特征性表现，是可以与ＨＣＣ鉴别；原发灶不详的孤立性肝转移瘤与ＨＣＣ较难鉴别，但ＣＴ增强显示的瘤周轮状强化以及ＭＲＩ呈现的炸面包圈征和靶征有助于诊断；毗邻肝脏的腹膜后或腹部肿瘤，术前如行血管造影，可作出定位诊断。组织学证实仍有赖于病理学检查。Purpose: To improve the diagnostic accuracy of the hepatocellular carcinoma (HCC). Materials and methods: The clinic, diagnostic imaging and laboratory data as well as the definite diagnosis, treatment and the follow up of five cases misdiagnosed as HCC before surgical therapy, were reviewed and analysed retrospectively. Results: Five cases misdiagnosed as HCC were confirmed pathologically as hepatic adenoma, biliary cystadenoma with malignant degeneration, isolated metastatic adenocarcinoma, malignant fibrous histocytoma of retroperitoneum and exogastric neurilemoma respectively. Of the 5 cases with surgical therapy, in 3 cases the mass couldn′t be resected because of the huge tumor with abundant blood supply, interventional therapy or/ and chemotherapy were used postsurgically in 4 cases. 3 of the 5 cases with benign tumor survived on 3 year follow up. Conclusion: Hepatic adenoma and biliary cystadenoma may be differentiated from HCC presurgically, if its characteristic features present on CT and angiography were recognized. Isolated metastasis of the liver with unknown site of primary tumor is difficult to differentiate from HCC, however, the ring like enhancement of the tumor in CT and the doughnut & target signs present on MRI may be helpful to diagnose. In the most of retroperitoneal or abdominal neoplasms nearby the liver, the locative diagnosis can be definite presurgically if angiography was undertaken. Finally, confirmation of these neoplasms described as above must be depend upon the pathological examination yet.

关 键 词：肝肿瘤 诊断 误诊 

分 类 号：R735.704[医药卫生—肿瘤]