肝样腺癌的临床特征及CT表现  

Clinical characteristics and CT features of hepatoid adenocarcinoma

作　　者：刘畅 毛国群 杨光钊[1] 孙娜娜[2] 刘希胜[2] LIU Chang;MAO Guoqun;YANG Guangzhao;SUN Nana;LIU Xisheng(Department of Radiology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]浙江省立同德医院放射科,浙江杭州310012 [2]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《实用放射学杂志》2020年第11期1781-1785,共5页Journal of Practical Radiology

摘　　要：目的分析肝样腺癌的临床特征及CT表现,以提高肝样腺癌的早期诊断率.方法回顾性分析10例经病理确诊为肝样腺癌患者的临床资料及CT资料,分析病灶位置、大小、形态特征、强化方式、淋巴结转移、邻近器官转移及侵犯等情况,总结其临床及影像学特征.结果10例患者中,6例治疗前血清甲胎蛋白(AFP)升高.发病部位分别为胃7例(胃窦5例、胃小弯2例)、肺2例及结肠1例.胃肝样腺癌表现为胃壁不规则增厚,呈不均匀渐进性强化,肺肝样腺癌表现为肺内分叶状肿块伴坏死,结肠肝样腺癌表现为肠壁稍增厚.入院时胃肝样腺癌患者中3例见淋巴结转移,1例见左侧肾上腺转移;1例肺肝样腺癌见肺内多发转移.免疫组化AFP表达阳性者9例,hepatocyte表达阳性者8例.9例患者行手术治疗,1例患者行化疗治疗.至末次随访时间,有4例患者在治疗后随访中发现肝及淋巴结转移.结论肝样腺癌为罕见肿瘤,血清AFP增高为其特点之一;该肿瘤好发于胃,CT增强后呈轻中度不均匀渐进性强化.Objective To analyze the clinical and CT features of hepatoid adenocarcinoma(HA),to improve the early diagnose ability.Methods The clinical and CT data of 10 cases with HA confirmed by pathology were retrospectively reviewed.The lesion size,morphology,enhancement pattern,lymphadenopathy and adjacent organ invasion were analyzed,and the clinical and imaging characteristics were summarized.Results For 10 patients,six patients had elevated serum alpha-fetoprotein(AFP)before surgery.The tumors located in stomach[n=7,antrum(n=5),lesser curvature(n=2)],lung(n=2)and colon(n=1).The CT findings of HA of the stomach appeared as irregular thicken gastric wall with homogeneously progressive enhancement.The CT findings of HA of the lung appeared as lobulated mass with necrosis.The CT findings of HA of the colon appeared as colon wall slightly thickened.3 patients had the lymphatic metastasis,1 patient had the left adrenal metastasis;and 1 had the lung metastasis before surgery.In immunohistochemistry,AFP positive expression was found in 9 cases,hepatocyte positive expression was found in 8 cases.As for treatment,9 patients were treated by surgery and 1 patient received chemotherapy.As of the last follow-up,4 patients had heptic or lymphatic metastasis after treatment.Conclusion HA is a rare tumor.One of its characteristics is the increase of serum AFP.The tumor mainly occurs in the stomach and it shows mild to moderate heterogeneous enhancement.

关 键 词：肝样腺癌 计算机体层成像 预后 

分 类 号：R735.7[医药卫生—肿瘤] R735[医药卫生—临床医学]