肝脏上皮样血管内皮瘤:影像表现和病理基础  

Hepatic Epithelioid Hemangioendothelioma:Imaging and Pathologic Findings

作　　者：吕鹏[1] 林江[1] 周易[1] 曾蒙苏[1] 

机构地区：[1]复旦大学附属中山医院放射诊断科,上海市枫林路180号上海200032

出　　处：《中国医学计算机成像杂志》2011年第5期416-419,共4页Chinese Computed Medical Imaging

摘　　要：目的:分析肝脏上皮样血管内皮瘤(EHE)的CT和MRI表现,并与病理结果对照。方法:经病理证实的肝脏EHE10例,10例均行多排螺旋CT平扫和动态增强扫描;其中5例行MR检查,包括平扫和动态增强成像;其中1例行选择性肝动脉造影。将影像学结果与病理结果作对照分析。结果:共检出病灶80个,最大直径3.0～44.6mm,平均(17.8±7.0)mm,病灶分布于肝脏各段,其中31个病灶紧邻肝包膜下生长。5例患者MR检出40个病灶,T1WI均示低信号,T2WI示中高信号。5例均可见包膜回缩征,增强后10个病灶呈晕征。CT平扫10例患者共80个低密度灶,其中26个出现融合。2例患者病灶内见钙化,8例见包膜回缩征,增强扫描38个病灶呈晕征,且门脉期显示更清晰。1例选择性血管造影显示肝实质边缘斑片状染色伴周围细小血管。组织学上示病变纤维组织及血管样结构增生,其间见散在的形态不规则的上皮样细胞,其内见印戒样结构。免疫组织化学染色示10例CD34全部阳性,5例CD31阳性,4例FVIIIRAg阳性。结论:肝脏EHE可表现为单发结节和弥漫结节,多位于肝包膜下生长,结节可融合,可具有晕征及包膜回缩征,MRI对晕征的显示较CT好。Purpose： To analyze the CT and MRI features of hepatic epithelioid hemangioendothelioma （EHE） with the correlative study of pathology. Methods： Ten cases of hepatic EHE confirmed by pathol ogy underwent plain and dynamic contrast enhanced multi detector row CT examination. Five of them underwent additional MRI including plain TI weighted imaging （Ti WI）, T2 - weighted imaging （T2 WI） and dynamic contrast enhanced scanning. One of them underwent selective hepatic arteriography. The imaging findings were reviewed retrospectively of 80 lesions, ranging from 3.0 mm to 44.6 mm in comparison with pathological results. Results： A total in maximum diameter, and with an average of 17.8 ± 7.0 ram, were found in various segments of livers. Thirty one of the 80 lesions grew adjacent to the hepatic capsule. In 5 cases underwent MRI, 40 lesions were found with low signal intensity on T, WI, interme diate to high signal intensity on T2WI. The ＂ capsular retraction＂ sign was found in all 5 cases. Ten le sions showed ＂ halo＂ sign on post - contrast MRI. Eighty hypodense nodules in 10 cases were shown on unenhanced plain CT, and 26 of them were confluent. Calcification was found in 2 patients. ＂ Capsular retraction＂ sign was found in 8 cases. Thirty eight lesions demonstrated ＂ halo＂ sign on post - contrast CT, and this sign was more clearly demonstrated on the portal venous phase. In one case, selective hep- atic arteriography showed patchy stain in the peripheral area of liver parenchyma with small vessels around them. In all cases, histology results revealed proliferation of abnormal fibrous tissue and vessel like structure which were scattered with irregular epithelioid cells and signet ring- like structure. By immunohistochemical staining, all cases were positive for CD34, 5 cases were positive for CD31 and 4 cases were positive for factor VIII related antigen. Conclusion： Hepatic EHE may manifest as solitaryor diffuse nodular lesions with predilection of peripheral subcapsular grow

关 键 词：肝脏 上皮样血管内皮瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤]