肝脏局灶性结节性增生12例临床病理观察  

Hepatic focal nodular hyperplasia:a clinicopathologic study of 12 cases

作　　者：陈鲜 傅静[2] 吕春燕[3] 

机构地区：[1]三六三医院病理科,四川成都610041 [2]四川省医学科学院.四川省人民医院病理科,四川成都610072 [3]成都市第五人民医院病理科,四川成都611130

出　　处：《实用医院临床杂志》2013年第1期108-111,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)的临床病理特征及鉴别诊断要点。方法收集12例FNH病例,对其临床特征、病理形态学特征及免疫组化染色进行观察分析。结果 12例FNH临床表现无特异性;肿块最大径1～8 cm,平均3 cm;7例可见特征性的放射状瘢痕;镜下肿块由增生性肝细胞构成,呈1～2层肝细胞排列,细胞无异型性,结节之间为杂乱的纤维间隔,典型的星状瘢痕由增生的纤维组织、薄壁小静脉、厚壁肝动脉、增生小胆管和数量不等的淋巴细胞构成,中央瘢痕内的动脉壁不规则增厚;周围肝组织无肝硬化背景。免疫表型:CK19纤维间隔内增生的胆小管(+);12例均无Glypican3、AFP、HBsAg等表达;Ki-67阳性率平均约5%。结论 FNH是肝脏较少见的良性增生性病变,其发生可能与肝内局部血管异常有关,病理诊断需要与肝硬化、肝细胞腺瘤、肝细胞癌等进行鉴别诊断,免疫组化染色尤其是CK19显示纤维分隔内增生的胆小管对FNH鉴别诊断具有参考价值。Objective To study the clinicopathologic features and differential diagnosis of hepatic focal nodular hyperplasia （FNH）. Methods Clinical manifestation, pathological morphology and immunohistochemistry of 12 cases of FNH were studied. Results 12 cases of FNH had no specific clinical manifestation. Grossly, the size of these lesions measured 1 cm to 8 cm in diameter, with an average of 3 em. 7 cases had characteristic stellate scar. Microscopically, the lesion consisted of disorganized regenerative nodules？ separated by fine fibrous septa. The proliferative hepatocytes were without cellular atypia, arranged one to two cells thick. The typical stellate scar consisted of a proliferation of fibrous tissue, thin-walled venules, thick-walled arteries, bile ductules and varying amounts of lymphocytes. The wall of arteries in the central scar was irregularly thickened. No cirrhosis was present in the surrounding liver tissue. Immunohistochemically, the bile ductules in fibrous septa were positive for CK19. All cases were negative for Glypican 3, AFP and HB- sAg. The average of Ki-67 index was about 5%. Conclusion FNH is a rare benign proliferative lesion of liver and may be associated with local vascular anomaly. Differential diagnosis of FNH includes cirrhosis, hepatic adenoma and hepatocellular carcinoma. Immuno- histochemistry may be helpful for accurate diagnosis and differential diagnosis of FNH, especially when bile ductules were positive for CK19 in the fibrous septa.

关 键 词：肝脏 局灶性结节性增生 诊断 鉴别诊断 免疫组织化学 

分 类 号：R365[医药卫生—病理学] R333.4[医药卫生—基础医学]