摘要
目的探讨原发性肝癌肉瘤的CT表现特点,以提高对该病的认识。方法收集经手术病理证实的7例肝癌肉瘤患者的临床及CT检查资料,进行回顾性分析。结果本研究收集2009年1月-2018年2月广西医科大学第一附属医院收治的肝脏原发性癌内瘤患者7例,其中6例为男性,1例为女性,年龄42~64岁。患者均以腹痛为主要临床症状就诊。3例有肝硬化病史,4例有慢性乙型肝炎病史。3例患者CA199、AFP阳性,1例患者CA125阳性。肿瘤的最大直径为7.0~27.0 cm,4例肿瘤周边有纤维组织假包膜形成。7例肿瘤组织均由癌性成分与肉瘤成分混杂排列而成,癌性成分包括:肝细胞癌5例,胆管细胞癌2例;肉瘤成分包括:纤维肉瘤4例,血管肉瘤2例,恶性纤维组织细胞瘤1例。7例患者均行CT平扫及三期对比增强扫描。7例肿瘤均为体积巨大的单发病灶,3例为外生型,4例局限于肝轮廓内,3例类圆形,4例不规则形。CT平扫,肿瘤呈不均匀低密度影,内见大片状坏死囊变或厚壁分隔多房囊变区。三期增强扫描显示病灶表现为边缘向中心逐渐填充强化,动脉期肿瘤实质表现为轻中度强化,门静脉期及延迟期肿瘤实质较周围肝实质表现为稍低密度(4例)或出现等密度区(3例)。结论原发性肝癌肉瘤是临床上罕见的恶性肿瘤,CT检查显示肝脏来源的巨大肿块、肿瘤中心大片状或不规则厚壁多房囊变、三期增强扫描表现为边缘向中心逐渐填充强化、门静脉期和延迟期肿瘤实质呈稍低密度或出现等密度区等CT征象,有助于肝癌肉瘤的诊断。
Objective Purpose We studied the CT features of primary liver carcinosarcoma in order to raise the awareness of it. Methods Clinical and CT data of 7 cases of liver carcinosarcoma proved by operation and pathology were collected, and retrospectively analyzed. Results A total of 7 patients were included in this study from January 2009 to February 2018, 6 of whom were male and 1 female. The patient’s age range was 42-64. All patients were treated with abdominal pain as the main clinical symptom. Three patients had a history of cirrhosis. Four patients had a history of chronic hepatitis B. CA199 and AFP were positive in 3 patients and CA125 positive in one patient. The inner diameter of the tumor was 7.0-27.0 cm. Four cases of showed pseudocapsular formation of fibrous tissue around the tumor. Tumor tissues in 7 cases were composed of carcinomatous components and sarcomatous components. The carcinomatous components included 5 cases of hepatocellular carcinoma and 2 cases of cholangiocarcinoma. The components of sarcoma included fibrosarcoma in 4 cases, angiosarcoma in 2 cases and malignant fibrous histiocytoma in 1 case. All 7 patients underwent plain CT scan and three phase contrast enhanced scan. All 7 cases of tumor were single lesions with huge volume. Of them, 3 cases had protruding hepatic contour and 4 cases had tumor localized in the contour of liver. Three cases of tumors were round, four cases of tumors were irregular. On plain CT scan, the tumor showed inhomogeneous and low density. Large flake or thick-walled septal multilocular cystic areas can be seen in the lesion. In contrast, enhanced CT scan, the lesions showed gradual enhancement of the edge to the center on the three phase of contrast enhanced imaging. At arterial stage, the tumor’s parenchyma presented as mild and moderate enhancement. In portal and delayed phase, the density of tumor parenchyma was slightly lower in 4 cases and equal in 3 cases. Conclusion Primary liver carcinosarcoma is a rare malignant tumor in clinic. These CT signs such
作者
陆力坚
黄璐
LU Li-jian;HUANG Lu(Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China)
出处
《中华全科医学》
2020年第2期277-281,共5页
Chinese Journal of General Practice
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170591)。
