易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

炎性肝细胞腺瘤是最常见的亚型,占所有肝细胞腺瘤的40%~50%。炎性肝细胞腺瘤包括以前的“毛细血管扩张型局灶性结节增生”或者“毛细血管扩张性腺瘤”。炎性肝细胞腺瘤多见于口服避孕药用药史的年轻女性和肥胖病人。炎性肝细胞腺瘤病人可以表现为慢性贫血和/或全身性炎症,特征为发热,白细胞增高和C反应蛋白增高。病人可以出现异常的肝功能结果,包括血清转氨酶水平,碱性磷酸酶,尤其是出现瘤内出血和多发腺瘤的病人。

肝细胞腺瘤最常见的两大并发症是a肿瘤内出血并破裂和肝细胞癌。不同亚型的肝细胞腺瘤具有不同的并发症发生率。肿瘤内出血可以发生于20~25%的肝细胞腺瘤;最大径大于5cm和包膜下肿瘤更容易出血破裂。在所有的亚型中,炎性肝细胞腺瘤具有最高的出血发生率,可以占到30%。

大体病理学上,炎性肝细胞了表现不均质,可见淤血区和出血。组织病理学上,炎性肝细胞腺瘤可见广泛地多形性炎性浸润,明显的窦样扩张和淤血和厚壁动脉。肿瘤细胞对急性炎症因子(例如血清淀粉样蛋白A和C反应蛋白)具有免疫反应。

磁共振T2WI上,炎性肝细胞腺瘤表现为弥漫性高信号影,病变周围表现为更高信号影,与窦样扩张具有相关性。T1WI上,炎性肝细胞腺瘤表现为等或稍高信号影。反相位图像上轻度或者没有信号强度下降。注射钆对比剂后,炎性肝细胞腺瘤通常表现为动脉期明显强化,持续到门静脉期和延迟期。

明显T2WI高信号和延迟强化诊断炎性肝细胞腺瘤的敏感性为85%,特异性为87%。多层螺旋CT上,炎性肝细胞腺瘤可以表现为平扫CT不均匀性高密度肿块,增强特点类似磁共振。增强超声上,炎性肝细胞腺瘤表现为动脉期向心性充盈,周边持续性强化和中心性静脉晚期廓清。增强超声的延迟廓清在T1WI增强检查上没有出现,可能与钆向间质的扩散有关,但是微泡不会扩散入间质。

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

Multiple inflammatory hepatocellular adenomas in a 45-year-old woman with long-term use of oral contraceptive pills. (a, b) Axial T2-weighted (a) and T1-weighted (b) MR images depict multiple focal hepatic lesions that are hyperintense on the T2-weighted image (arrows in a) and isointense to slightly hyperintense on the T1-weighted image (arrow in b). (c, d) Contrast-enhanced T1-weighted MR images obtained in the arterial (c) and portal venous (d) phases show the lesions with intense arterial phase enhancement (arrows in c), which persists into the portal venous phase (arrows in d). The findings from histopathologic examination of the specimen from percutaneous core biopsy helped confirm the diagnosis of inflammatory hepatocellular adenoma.

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

易出血可癌变的肝细胞腺瘤——炎性肝细胞腺瘤

Ruptured inflammatory hepatocellular adenoma in a 30-year-old woman presenting with acute right upper quadrant pain. Axial CT images obtained at the level of the liver in the nonenhanced phase (a, b) and the hepatic arterial (c) and portal venous (d) phases show a focal lesion involving the right lobe of the liver. On the nonenhanced images, the lesion is heterogeneously hyperattenuating (arrows in a) compared to the liver, with associated hemorrhage (arrows in b) in the perihepatic space, a finding consistent with rupture. The mass shows heterogeneous enhancement during the arterial phase (arrows in c) and is iso- to hypoattenuating compared to the hepatic parenchyma in the portal venous phase (arrows in d). In addition, in the arterial phase, the left hepatic lobe has an enhancing focal lesion (arrowheads in c), which is isoattenuating to mildly hyperattenuating in the portal venous phase (arrowheads in d), a finding consistent with a second hepatocellular adenoma. The findings from surgical resection with histologic examination helped confirm the diagnosis of inflammatory hepatocellular adenoma.

来源:丁香园

RadioGraphics,

http://pubs.rsna.org/doi/abs/10.1148/rg.316115527

Published in: Venkata S. Katabathina; Christine O. Menias; Alampady K. P. Shanbhogue; Jaishree Jagirdar; Raj Mohan Paspulati; Srinivasa R. Prasad; RadioGraphics  2011, 31, 1529-1543.

DOI: 10.1148/rg.316115527

© RSNA, 2011

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