原发性肝脏肉瘤CT表现与病理对照研究  

CT and pathologic features of primary hepatic malignant sarcoma

作　　者：谭艳[1] 肖恩华[2] 

机构地区：[1]山西医科大学第一医院影像科,太原030001 [2]中南大学湘雅二医院放射科

出　　处：《中华消化病与影像杂志（电子版）》2012年第4期20-23,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：国家"十一五"科技计划项目(2007BAI05B06);国家自然科学基金(30070235;30470508;30870695);湖南省自然科学基金(06JJ20081;07JJ6040)

摘　　要：目的研究原发性肝脏肉瘤CT表现及其病理基础，探讨CT诊断原发性肝脏肉瘤的价值。方法回顾性分析2005—2011年中南大学湘雅二医院经手术病理证实的8例原发性肝脏肉瘤患者CT表现及病理表现。结果8例原发性肝脏肉瘤患者中平滑肌肉瘤2例，癌肉瘤2例，血管肉瘤2例，纤维肉瘤1例，未分化肉瘤1例。患者间断性右上腹不适或疼痛6例，乏力、纳差1例，无明显症状1例。所有患者均无乙肝及肝硬化病史，肿瘤标志物甲胎蛋白均为阴性。CT平扫示8例患者均为单发肿块或肿块伴有子灶（肝右叶7例，肝左叶1例），直径5～15cm（平均9．5cm），密度不均、边界不清4例；CT增强扫描示6例肿块呈不均匀强化，2例肿块强化不明显，其中1例未分化肉瘤、2例癌肉瘤、1例纤维肉瘤及1例血管肉瘤呈不均匀渐进性强化，延迟扫描实性部分强化呈等密度，1例平滑肌肉瘤呈持续性明显强化，1例平滑肌肉瘤及1例血管肉瘤未见明显强化。结论动态CT扫描能较好地显示原发性。肝脏肉瘤内部结构及邻近结构侵犯。结合病史、实验室检查及CT表现，能鉴别原发性肝脏肉瘤与典型的原发性肝细胞癌、胆管细胞癌，但具体病理类型需依靠病理检查确诊。Objective To analyze the CT imaging and pathologic features of primary hepatic malignant sarcoma （PHMS） , and explore the diagnostic value of CT. Methods CT imaging and pathologic features of 8 PHMS who were diagnosed by pathology during 2005-2011 in the Second Xiaugya Hospital of Central South University were analyzed retrospectively. Results There were 2 cases of leiomyosarcoma, 2 hepatic carcinosarcoma,2 angiosarcoma, 1 fibrosarcoma and 1 undifferentiated of 8 PHMS. Six patients presented with intermittent right upper quadrant abdominal discomfort or pain, 1 presented with fatigue and anorexia, 1 patient had no obvious symptom. All of them did not have the history of hepatitis B infection and liver cirrhosis, and alpha fetal protein was negative. The performance of plan CT revealed that tumors were single irregular mass （right lobe 7 cases, left lobe 1 case） , the maximum diameters were 5-15 cm（ mean 9.5 cm） , the density was inhomogeneous（4 cases） , with ill-defined border （4 cases） , enhanced CT scan showed that lesions heterogeneous enhanced （6 cases） , and 2 cases had no obviously enhancement. One case of undifferentiated sarcoma, two cases of carcinosarcoma, one case of fibrosarcoma and one case of angiosarcoma had heterogeneous progressive enhancement, the solid part was isodense on the delayed phase; one case of leiomyosarcoma had significantly persistent enhancement; one case of leiomyosarcoma and one case of angiosarcoma had no significant enhancement. Conclusions CT could detect the internal structure and near organ invasion of PHMS. PHMS can be easily identified with typical hepatocellular carcinoma and cholangiocarcinoma combining history, laboratory tests and CT findings, but the specific pathological type depends on the pathological diagnosis.

关 键 词：肝肿瘤 肉瘤 体层摄影术 X线计算机 病理学 

分 类 号：R735.7[医药卫生—肿瘤]