肝血管平滑肌脂肪瘤的诊断及治疗  

Diagnosis and treatment of hepatic angiomyolipoma

作　　者：王长辉[1] 支庆江[1] 高恒岭[1] 姜小青[2] 

机构地区：[1]聊城市第二人民医院普外科,山东聊城252601 [2]第二军医大学附属东方肝胆外科医院胆道科,上海200000

出　　处：《肝胆胰外科杂志》2010年第4期306-309,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨肝血管平滑肌脂肪瘤的临床、影像及病理特征,以提高诊断率。方法对1994-2009年间我院及东方肝胆外科医院手术后病理学检查证实的8例HAML患者的临床资料进行回顾性分析。结果临床无明显症状者5例,腹部不适者2例,腹部包块1例;肿瘤最大直径8.5 cm,位于肝左叶3例,右叶5例。B超检查8例,显示肿块边界清楚,强回声或混合回声光团5例,中等回声1例,低回声2例。肝CT平扫8例,占位呈低密度6例,混杂密度2例;4例增强扫描动脉期肿块明显强化,门脉期及延迟期持续强化。4例行MRI检查T1加权高信号3例、低信号1例;T2加权高信号3例,提示有脂肪成分者1例。8例均手术切除,术后送病理镜下示:主要由畸形血管、平滑肌样细胞和成熟的脂肪细胞3种成分以不同比例组成。免疫组织化学染色,HMB-45均呈阳性表达。结论肝血管平滑肌脂肪瘤临床缺少特异表现,容易误诊,综合分析超声、CT、MRI等影像特征有助于提高术前诊断率,免疫组化HMB-45阳性表达有助于病理确定诊断。Objective To investigate the clinical,imaging and pathological features of hepatic angiomy-olipoma（HAMI）,so as to improve the rate of diagnosis.Methods The clinical data of 8 cases with HAML that were confirmed by pathology after operation in our hospital and the Eastern Hepatobiliary Surgery Hospital from 1994 to 2009 were retrospectively analyzed.Results Among the 8 cases,5 cases were asymp-tomatic,2 cases were abdominal discomfort,1 case had abdominal mass.The largest diameter of tumor was 8.5 cm,three cases’ tumor located in left hepatic lobe and the others located in right hepatic lobe.All the 8 cases received ultrasonography examination,the tumors were well-defined,5 cases displayed dense echo or commixture echo,1 cases displayed medium echo-level,2 cases displayed low echo-level.All patients had plain CT scan,6 cases showed low density shadows,2 cases showed mixture density shadows.4 cases had enhanced CT scan,showed obvious enhancement in artery phase,persistent enhancement in portal vessel phase and lag phase.Among 4 cases undergone MRI,3 cases showed high signal and 1 case showed low signal in T1WI and 3 cases showed high signal in T2WI.8 cases underwent operation.The tumor under microscopy were mainly made up of malformation arteriovenous,smooth muscle cells and mature fat cells with different ratio.The myoid cells in all tumors showed positive-expression of HMB-45 by immunohistochemistry.Conclusion Patients with HAML have no specific manifestation and can be misdiagnosed easily.The combination of imaging data of ultrasonography,CT and MRI is helpful for the diagnosis before operation.The expression of HMB-45 by immunohistochemistry can be used to confirm the diagnosis.

关 键 词：肝脏 血管平滑肌脂肪瘤 影像 病理 免疫组化 诊断 

分 类 号：R735.7[医药卫生—肿瘤]