肝脏肉瘤样癌影像及病理表现分析  

Clinical Imaging Characteristics and Pathological Features of Sarcomatoid Hepatocellular Carcinoma

作　　者：翟晓力[1] 王立侠[1] 李雪[2] ZHAI Xiali;WANG Lixia;LI Xue(Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]首都医科大学附属北京朝阳医院病理科,北京100020

出　　处：《CT理论与应用研究（中英文）》2022年第3期409-416,共8页Computerized Tomography Theory and Applications

摘　　要：目的:探讨肝脏肉瘤样癌(SHC)的影像学表现及临床病理特征。方法:回顾性分析7例SHC患者的临床、CT/MRI表现及病理特征,并对其一致性进行评价。结果:SHC在CT平扫上表现为病灶边界不清,呈低密度,大小范围从4.2 cm×4.7 cm至14.0 cm×11.0 cm不等。增强CT扫描显示病灶呈环形或早期强化,多见大片坏死区。MRI上T1WI及T2WI病变实质信号不均匀,可见囊性变和坏死区,DWI呈明显的弥散限制性改变;增强扫描表现为病灶边缘及实性成分渐近性强化并可见假包膜出现延迟强化,6例病灶中心出现不同程度坏死;5例有淋巴结转移。病理特征:SHC细胞呈多角型和梭形,肿瘤组织内可见广泛坏死及出血;免疫组化染色Vimentin、CK为阳性。结论:SHC的影像表现与病理学特征具有较好一致性,有助于深入了解SHC特征性影像学表现,有益于肝脏肿瘤的诊断和鉴别诊断。Objective: To explore the imaging manifestations and clinical-pathological features of sarcomatoid hepatocellular carcinoma(SHC). Methods: The clinical data, CT/MRI findings and pathological features of 7patients with SHC were retrospectively analyzed and the consistency was evaluated. Results: SHC showed unclear boundary and low density by plain CT images, with the size ranging from 4.2 cm × 4.7 cm–14.0 cm × 11.0 cm. By enhanced CT images, SHC showed ring or early enhancement with large areas of necrosis. SHC showed heterogeneous signal intensity on T1WI and T2WI with visible cystic degeneration and necrotic area while DWI displayed obvious diffusion restricted changes. On enhanced MRI, the tumor showed progressive enhancement of peripheral and solid components with delayed enhanced pseudo-capsule. 6 cases had different degree of necrosis in the center of lesion, and lymph node metastasis in the livers hilar was found in 5 patients. Pathological features polygonal and fusiform tumor cells with extensive necrosis and hemorrhage were found on HE staining. Vimentin and CK were positive by immunohistochemical staining. Conclusions: The imaging findings of SHC were consistent with the pathological features, which was helpful to deep understanding of specific imaging manifeatations, and the diagnosis and differential diagnosis of liver tumors.

关 键 词：计算机体层摄影 肝脏肉瘤样 病理表现 

分 类 号：R814[医药卫生—影像医学与核医学]