小肝癌假包膜MRI动态增强影像表现和病理分级对照研究
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摘要
目的探讨小肝癌假包膜与磁共振动态增强扫描方式及病理分级的相关性。方法回顾性分析46例小肝癌患者资料52个病灶经病理证实,根据MRI动态增强扫描图像有无假包膜分为A、B两组,A组23个,显示无明显假包膜;B组29个显示有假包膜。记录所有病例肿瘤大小、MRI强化方式;病理学分析记录肿瘤新生血管、血管瘤栓以及病理分级。两组间MRI强化方式和病理学特点比较用卡方检验和Fisher's确切概率法。结果肿瘤最小直径0.8 cm,最大直径3 cm,平均2.13 cm,A组平均直径约1.88 cm,B组直径约2.36 cm。当小肝癌在<1 cm以及2～3 cm时两组有统计学差异;两组间均匀强化以及病理分级2、3级有统计学差异。结论小肝癌假包膜与肿瘤大小、强化方式以及病理学分级有相关性。
Objective To investigate the correlation between the pseudo-capsule of small hepatocellular carcinoma and the dynamic enhancement mode and pathological grade of magnetic resonance.Methods A retrospective analysis of 52 patients with pathologically confirmed small hepatocellular carcinoma was performed according to MRI dynamic enhancement images with or without false capsules.Group A had 23 cases and dynamic enhanced MRI showed no obvious pseudocapsule;Group B had 29 cases and dynamically enhanced MRI showed a pseudo-capsule.Tumor size and MRI enhancement were recorded in all cases.Pathological analysis recorded tumor neovascularization,vascular thrombosis,and pathological grade.The MRI enhancement and pathological features were compared between the two groups using chi-square test and Fisher's exact probability method.Results The minimum diameter of the tumor was 0.8 cm,the maximum diameter was 3 cm,with an average of 2.13 cm.The average diameter of group A was about 1.88 cm,and the diameter of group B was about 2.36 cm.There were significant differences between the two groups when the small liver cancer was less than 1 cm and 2-3 cm.There was a statistical difference between the two groups in the C-type enhancing mode and the pathological grade 2/3 group.Conclusion The pseudo-capsule of small hepatocellular carcinoma is associated with tumor size,enhancement pattern and pathological grade.
Objective To investigate the correlation between the pseudo-capsule of small hepatocellular carcinoma and the dynamic enhancement mode and pathological grade of magnetic resonance.Methods A retrospective analysis of 52 patients with pathologically confirmed small hepatocellular carcinoma was performed according to MRI dynamic enhancement images with or without false capsules.Group A had 23 cases and dynamic enhanced MRI showed no obvious pseudocapsule;Group B had 29 cases and dynamically enhanced MRI showed a pseudo-capsule.Tumor size and MRI enhancement were recorded in all cases.Pathological analysis recorded tumor neovascularization,vascular thrombosis,and pathological grade.The MRI enhancement and pathological features were compared between the two groups using chi-square test and Fisher's exact probability method.Results The minimum diameter of the tumor was 0.8 cm,the maximum diameter was 3 cm,with an average of 2.13 cm.The average diameter of group A was about 1.88 cm,and the diameter of group B was about 2.36 cm.There were significant differences between the two groups when the small liver cancer was less than 1 cm and 2-3 cm.There was a statistical difference between the two groups in the C-type enhancing mode and the pathological grade 2/3 group.Conclusion The pseudo-capsule of small hepatocellular carcinoma is associated with tumor size,enhancement pattern and pathological grade.
引文
1王艳苓,张蓉.原发性肝癌发生相关因素研究进展[J].肝脏,2016,21:515-518.
2 Forner A,Vilana R,Ayuso C,et al.Diagnosis of hepatic nodules20mm or smaller in cirrhosis:Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma[J].Hepatology,2008,47:97-104.
3 Cong WM,Wu MC.The biopathologic characteristics of DNA content of hepatocellular carcinomas[J].Cancer,1990,66:498-501.
4 Franco D,Capussotti L,Smadja C,et al.Resection of hepatocellular carcinomas:results in 72 European patients with cirrhosis[J].Gastroenterology,1990,98:733-738.
5 Ng IO,Lai EC,Ng MM,et al.Tumor encapsulation in hepatocellular carcinoma:a pathologic study of 189 cases[J].Cancer,1992,70:45-49.
6 Kojiro M.Histopathology of liver cancers[J].Best Practice&Research Clinical Gastroenterology,2005,19:39-62.
7 Grazioli L,Olivetti L,Fugazzola C,et al.The pseudocapsule in hepatocellular carcinoma:correlation between dynamic MR imaging and pathology[J].Eur.Radiol,1999,9:62-67.
8 Itoh K,Nishimura K,Togashi K,et al.Hepatocellular carcinoma:MRimaging[J].Radiology,1987,164:21-25.
9 Ishizaki M,Ashida K,Higashi T,et al.The formation of capsule and septum in human hepatocellular carcinoma[J].Virchows Arch,2001,438:574-580.
10 Torimura T,Ueno T,Inuzuka S,et al.Mechanism of fibrous capsule formation surrounding hepatocellular carcinoma:immunohistochemical study[J].Arch Pathol Lab Med,1991,115:365-371.
11 Wakasa K,Sakurai M,Okamura J,et al.Pathological study of small hepatocellular carcinoma:frequency of their invasion[J].Virchows Arch Anathol Anat,1985,407:259-270.
12 Okuda K,Musha H,Nakajima Y,et al.Clinicopathologic features of encapsulated hepatocellular carcinoma:a study of 26 cases[J].Cancer,1977,40:1240-1245.
13 Nagao T,Inoue S,Goto S,et al.Hepatic resection for hepatocellular carcinoma:clinical features and long-term prognosis[J].Ann Surg,1987,205:33-40.
14 Kemeny F,Vadrot J,Wu A,et al.Morphological and histological features of resected hepatocellular carcinoma in cirrhotic patients in the West[J].Hepatology,1989,9:253-257.
15 Yuki K,Hirohashi S,Sakamoto M,et al.Growth and spread of hepatocellular carcinoma:a review of 240 consecutive autopsy cases[J].Cancer,1990,66:2174-2179.
16 Adachi E,Maeda T,Kajiyama K,et al.Factors correlated with portal venous invasion by hepatocellular carcinoma:univariate and multivariate analyses of 232 resected cases without preoperative treatments[J].Cancer,1996,77:2022-2031.
17 Matsui O,Kobayashi S,Sanada J,et al.Hepatocelluar nodules in liver cirrhosis:hemodynamic evaluation(angiograph assisted CT)with special reference to multi-step hepatocarcinogenesis[J].Abdom Imaging,2011,36:264-272.
18 International Consensus Group for Hepatocellular Neoplasia.Pathologic diagnosis of early hepatocellular carcinoma:a report of the international consensus group for hepatocellular neoplasia[J].Hepatology,2009,49:658-664.
19 Ueda K,Matsui O,Kawamori Y,et al.Hypervascular hepatocellular carcinoma:evaluation of hemodynamics with dynamic CT during hepatic arteriography[J].Radiology,1998,206:161-166.
2 Forner A,Vilana R,Ayuso C,et al.Diagnosis of hepatic nodules20mm or smaller in cirrhosis:Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma[J].Hepatology,2008,47:97-104.
3 Cong WM,Wu MC.The biopathologic characteristics of DNA content of hepatocellular carcinomas[J].Cancer,1990,66:498-501.
4 Franco D,Capussotti L,Smadja C,et al.Resection of hepatocellular carcinomas:results in 72 European patients with cirrhosis[J].Gastroenterology,1990,98:733-738.
5 Ng IO,Lai EC,Ng MM,et al.Tumor encapsulation in hepatocellular carcinoma:a pathologic study of 189 cases[J].Cancer,1992,70:45-49.
6 Kojiro M.Histopathology of liver cancers[J].Best Practice&Research Clinical Gastroenterology,2005,19:39-62.
7 Grazioli L,Olivetti L,Fugazzola C,et al.The pseudocapsule in hepatocellular carcinoma:correlation between dynamic MR imaging and pathology[J].Eur.Radiol,1999,9:62-67.
8 Itoh K,Nishimura K,Togashi K,et al.Hepatocellular carcinoma:MRimaging[J].Radiology,1987,164:21-25.
9 Ishizaki M,Ashida K,Higashi T,et al.The formation of capsule and septum in human hepatocellular carcinoma[J].Virchows Arch,2001,438:574-580.
10 Torimura T,Ueno T,Inuzuka S,et al.Mechanism of fibrous capsule formation surrounding hepatocellular carcinoma:immunohistochemical study[J].Arch Pathol Lab Med,1991,115:365-371.
11 Wakasa K,Sakurai M,Okamura J,et al.Pathological study of small hepatocellular carcinoma:frequency of their invasion[J].Virchows Arch Anathol Anat,1985,407:259-270.
12 Okuda K,Musha H,Nakajima Y,et al.Clinicopathologic features of encapsulated hepatocellular carcinoma:a study of 26 cases[J].Cancer,1977,40:1240-1245.
13 Nagao T,Inoue S,Goto S,et al.Hepatic resection for hepatocellular carcinoma:clinical features and long-term prognosis[J].Ann Surg,1987,205:33-40.
14 Kemeny F,Vadrot J,Wu A,et al.Morphological and histological features of resected hepatocellular carcinoma in cirrhotic patients in the West[J].Hepatology,1989,9:253-257.
15 Yuki K,Hirohashi S,Sakamoto M,et al.Growth and spread of hepatocellular carcinoma:a review of 240 consecutive autopsy cases[J].Cancer,1990,66:2174-2179.
16 Adachi E,Maeda T,Kajiyama K,et al.Factors correlated with portal venous invasion by hepatocellular carcinoma:univariate and multivariate analyses of 232 resected cases without preoperative treatments[J].Cancer,1996,77:2022-2031.
17 Matsui O,Kobayashi S,Sanada J,et al.Hepatocelluar nodules in liver cirrhosis:hemodynamic evaluation(angiograph assisted CT)with special reference to multi-step hepatocarcinogenesis[J].Abdom Imaging,2011,36:264-272.
18 International Consensus Group for Hepatocellular Neoplasia.Pathologic diagnosis of early hepatocellular carcinoma:a report of the international consensus group for hepatocellular neoplasia[J].Hepatology,2009,49:658-664.
19 Ueda K,Matsui O,Kawamori Y,et al.Hypervascular hepatocellular carcinoma:evaluation of hemodynamics with dynamic CT during hepatic arteriography[J].Radiology,1998,206:161-166.