原发性肝血管肉瘤的病理与影像学对照

刘红山; 谢雨恩; 李坤芳; 廖锦元

doi:10.3969/j.issn.1674-4500.2017.04.01

原发性肝血管肉瘤的病理与影像学对照

doi: 10.3969/j.issn.1674-4500.2017.04.01

1.
广西医科大学第一附属医院放射科，广西南宁 530021
2.
广西桂林市人民医院放射科，广西桂林 541002

详细信息

作者简介:
刘红山，硕士，主治医师，E-mail: 1041956246@qq.com

通讯作者:
廖锦元，E-mail: 274264889@qq.com

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- 文章访问数: 1028
- HTML全文浏览量: 557
- PDF下载量: 24
- 被引次数: 0
出版历程
- 收稿日期: 2017-09-29
- 网络出版日期: 2017-10-01
- 刊出日期: 2017-10-01

Pathology and imaging of primary hepatic angiosarcoma

Hongshan LIU^{1,2
,},
Yuen XIE¹,
Kunfang LI¹,
Jinyuan LIAO^{1
, ,}

1.
Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
2.
Department of Radiology, The People's Hospital of Guilin, Guilin 541002, China

摘要

摘要: 目的观察原发性肝血管肉瘤的CT、MRI表现，与病理对照，分析其病理学基础。方法回顾性分析经病理证实的5例原发性肝血管肉瘤患者的CT、MRI表现，评价病灶的部位、大小、形态、密度（信号）特点、强化方式，并与病理对照观察。结果 5例病人中4例单发，1例多发。单发病例病灶类圆形或分叶状，CT平扫低密度，内密度不均，增强扫描渐进性强化，但至平衡期仍不能完全填充；1例MRI示T1WI低信号，T2WI高信号，信号不均，DWI高信号，增强扫描渐进性强化，延时仍不能完全填充。病理示病灶内可见出血、坏死及纤维化。结论原发性肝血管肉瘤的影像学表现有一定特征性，常表现为单发或多发肿块，易出血坏死，呈渐进性强化，延时期不能完全填充，可提示诊断，但特异性低，仍需病理检查方能确诊。
- 肝肿瘤 /
- 血管肉瘤 /
- 体层摄影术 /
- X线计算机 /
- 磁共振成像 /
- 病理学
Abstract: Objective To observe the CT、MRI findings of primary hepatic angiosarcoma (PHA) and analyze its pathological basis. Methods CT images (5 cases) and MR images (1 case) of PHA patients confirmed by histopathology were retrospectively analyzed. The location, size, form, density(signal)and enhancement pattern were evaluated. These findings were explored with histopathology findings. Results In 5 pateints, there were 4 of signle mass type, 1 of multiple mass. The dominant mass demonstrated lobular or round in shape. CT scan showed PHA in low density, within the uneven density. Enhanced scan was progressively strengthened, but it could not be completely filled on the equilibrium phase. One case showed heterogeneous hypointensity at T1WI, markedly hyperintersity at T2WI and DWI. It was not completely filled on equilibrium phase while enhancement were strengthened progressively. The pathological lesions showed hemorrhage, necrosis and fibrosis. Conclusion Imaging features of PHA have certain characteristics. PHA often show single or multiple mass with internal hemorrhage, necrosis, progressive enhancement. It can not be completely filled in delay period. These signs suggest the diagnosis with low specificity. Pathological examination is imprtant to confirm the diagnosis.
- liver neoplasm /
- primary hepatic angiosarcoma /
- tomography /
- X-ray computed /
- magnetic resonance imaging /
- pathology

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图 1 肝血管肉瘤多灶型，主灶位于肝右叶

A: 病理示肿瘤大部分坏死; B: 平扫为大片状低密度, 内见斑片状更低密度区; C~E: 病灶轻度强化, 门脉期及延时期渐进性强化, 内见斑片状不强化区.

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图 2 肝右叶单发血管肉瘤

A: 平扫为大片状低密度, 内见斑片状稍高密度出血灶; B~D: 病灶轻中度强化, 门脉期及延时期渐进性强化, 内见斑片状不强化区.

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图 3 肝右叶血管肉瘤

A: 病理示肿瘤高分化；B: 平扫为大片状稍低密度病灶; C~E: 病灶明显渐进性强化, 平衡期仍不能完全填充.

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图 4 肝右叶血管肉瘤

A: 平扫为不均匀低密度病灶, 内见斑片状稍高密度影及片状更低密度区; B~D: 病灶明显渐进性强化, 平衡期仍见大片无强化区.

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图 5 肝左叶血管肉瘤

A: 病理示肿瘤中-高分化, 内见多处出血灶; B: CT平扫为大片状稍低密度病灶, 内见小片状高密度出血灶; C~E: CT增强病灶明显强化，渐进性填充, 平衡期仍见斑片状不强化区; F：MRIT1WI大部分为稍低信号, 内见小片状高信号, 为出血灶; G: MRIT2WI大部分为明显高信号, 内见小片状低信号或更高信号区, 为出血、纤维灶或坏死区; H: DWI（b值=1000）为明显不均匀高信号; I: 动态增强扫描动脉期灶周结节状强化, 似海绵状血管瘤; J: 动态增强扫描延时期病灶不完全填充, 内见斑片状不强化区.

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