肝脏上皮样血管内皮瘤的临床病理特征及CT/MRI表现  

Clinical and Pathological Characteristics and CT/MRI Features of Hepatic Epithelioid Hemangioendothelioma

作　　者：李若坤[1,2] 林慧敏[1] 严福华[1] 强金伟[2] 陈晓炎[3] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科 [2]复旦大学附属金山医院放射科 [3]上海交通大学医学院附属瑞金医院病理科

出　　处：《中国医学计算机成像杂志》2017年第4期333-337,共5页Chinese Computed Medical Imaging

基　　金：中国博士后科学基金(N0.2016M591691);复旦大学第三批卓学计划(N0.2015-12)~~

摘　　要：目的:探讨肝脏上皮样血管内皮瘤(HEH)的临床病理特征及CT/MRI表现。方法 :回顾性分析18例HEH患者的临床、病理及CT/MRI资料,分析其影像学特征。结果:男性7例,女性11例,平均年龄52.4岁,肿瘤标志物均正常,1例有乙肝病史,7例有肝功能异常。影像上分为单发结节型(n=3)、多发结节型(n=4)和弥漫融合型(n=11)。共有195个病灶,其中127个病灶位于肝包膜下区。CT平扫均呈低密度,T1WI呈低信号,T2WI呈稍高信号,DWI呈高信号。113个病灶可见"靶征",CT上呈中心低密度,T2WI呈中心显著高信号、周边轻度高信号,病理上为黏液透明样物质、坏死和出血灶。动态增强扫描表现为轻度强化型(146/195)、环形强化型(32/195)和中心充填型(17/195)。4例可见"棒棒糖"征。6例有肝包膜皱缩,6例有肝外转移,包括淋巴结(n=2)、肺(n=4)和脾脏(n=1)。镜下,肿瘤周边富含细胞成分,中心主要为纤维间质,有不同程度的黏液样及透明样变。结论:HEH好发于无慢性肝病的中老年女性,影像上表现为包膜下分布为主的多发轻度强化病灶,靶征、肝包膜皱缩及棒棒糖征进一步支持该病诊断。Purpose： To investigate the clinical and pathological characteristics and CT/MRI features of hepatic epithelioid hemangioendothelioma （HEH）. Methods： Clinical information and CT/MRI images of 18 pathologically confirmed HEH were retrospectively reviewed. Results： Among the 18 HEH patients, there were seven males and 11 females with mean age of 52.4. They had no chronic liver disease except one with HBV infection. Mild abnormal liver function existed in seven. Levels of serum tumor markers （AFP, CEA, and CA19-9） were normal. HEH could be categorized as three types： solitary nodule type （n=3） , multiple nodules type （n=4） , and coalescent type （n=11） . A total of 195 lesions were detected in all 18 patients. All lesions appeared as hypo-density on CT, hypo-intensity on T1WI, hyper-intensity on T2WI and DWI. After administration of contrast media, the lesions demonstrated slight enhancement in 146, rim-like enhancement in 32 and progressive central filling in 17. The tumors showed ＂lollipop sign＂in 4 cases and capsular retraction in 6 cases. Extrahepatic metastases were identified in six case including lymph nodes （n=2）, lung （n=4） and spleen （n=l）. Microscopically, tumor cells mainly located at the peripherial region, and abundant fibrosis were identified at the center with myxoidand hyalinized degeneration. Conclusion： HEH mainly involves midaged women without history of chronic liver disease. Imaging features of HEH include multifocal hepatic disease, predominantly subcapsular location, and nodular coalescence together with target sign, lollipop sign and capsular retraction.

关 键 词：肝肿瘤 病理学 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]