肝上皮样血管内皮瘤1例
摘要
上皮样血管内皮瘤是一种罕见的低度恶性血管源性肿瘤,好发于软组织、肺及骨骼等部位,原发于肝部较为罕见。该文报告肝上皮样血管内皮瘤1例。患者因剑突下不适1个月,停经15天就诊。胃镜检查提示无异常,超声检查提示肝脏多发实质性占位,遂收治入院。全腹CT平扫及动态三期增强扫描显示,肝多发低密度肿块,大多分布于肝周围及包膜下,大小不等;部分病灶互相融合,无钙化;病灶中心可见更低密度区,动态增强呈环状渐进性强化,形态似"牛眼征",部分病灶周围动脉期出现异常灌注,部分病灶内可见肝动脉及门静脉血管进入,多平面重建(MPR)可见"棒棒糖征",靠近肝包膜的病灶局部出现凹陷性改变,呈"包膜退缩征"表现。提示肝多发占位性病变,考虑肝原发性肿瘤(血管内皮瘤可能),不排除转移瘤及其他。为进一步明确诊断,行超声引导下肝穿刺活检术。病理检查确诊为肝上皮样血管内皮瘤。该病例提示,虽然肝上皮样血管内皮瘤临床症状和实验室检查均无特异性,但其生长方式、CT强化特点及"包膜退缩征""棒棒糖征"等影像学表现具有一定特征性,可作为重要的辅助诊断依据。临床医师应提高对本病的认识,做好疾病的诊断与鉴别诊断,及早确诊,及早治疗,使患者获得良好预后。
引文
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[5] 朱愉,陈实,沈柏用,等.肝上皮样血管内皮瘤伴转移1例[J].中华现代外科学杂志,2009,6(5):318-319.
[6] Lin J,Ji Y.CT and MRI diagnosis of hepatic epitheloid hemangioendothelioma[J].Hepatobiliary Pancreat Dis Int,2010,9(2):154-158.
[7] 周丽莎,翟凤仪,董帜,等.肝脏上皮样血管内皮瘤的 CT 和 MRI 表现[J].临床放射学杂志,2015,34(3):402-405.
[8] 赵越,龙世亮,田执南,等.肝上皮样血管内皮瘤的 CT 与 MRI 特征及病理基础[J].CT 理论与应用研究,2015,24(4):563-569.
[9] 刘权,彭卫军,王坚.肝上皮样血管内皮瘤影像学表现及征象分析[J].肿瘤影像学,2014,23(1):8-13.
[10] Woodall CE,Seoggins CR,Lewis AM,et al.Hepatic malignan epithelioid hemangioendothelioma:A case report and review of the literature[J].Am Surg,2008,74(1):64-68.
[2] Hert M,Cosimi AB.Liver transplantation for malignancy[J].Oncologist,2005,10(4):269-281.
[3] Mehrabi A,Kashfi A,Fonouni H,et al.Primary malignant hepatic epithelioid hemangioendothrlioma:A comprehensive review of the literature with emphasis on the surgical therapy[J].Cancer,2006,107(9):2108-2121.
[4] Ishak KG,Sesterhenn IA,Goodman ZD,et al.Epithelioid hemangioendothelioma of the liver:A clinicopathologic and follow-up study of 32 cases[J].Huam Pathol,1984,15(9):839-852.
[5] 朱愉,陈实,沈柏用,等.肝上皮样血管内皮瘤伴转移1例[J].中华现代外科学杂志,2009,6(5):318-319.
[6] Lin J,Ji Y.CT and MRI diagnosis of hepatic epitheloid hemangioendothelioma[J].Hepatobiliary Pancreat Dis Int,2010,9(2):154-158.
[7] 周丽莎,翟凤仪,董帜,等.肝脏上皮样血管内皮瘤的 CT 和 MRI 表现[J].临床放射学杂志,2015,34(3):402-405.
[8] 赵越,龙世亮,田执南,等.肝上皮样血管内皮瘤的 CT 与 MRI 特征及病理基础[J].CT 理论与应用研究,2015,24(4):563-569.
[9] 刘权,彭卫军,王坚.肝上皮样血管内皮瘤影像学表现及征象分析[J].肿瘤影像学,2014,23(1):8-13.
[10] Woodall CE,Seoggins CR,Lewis AM,et al.Hepatic malignan epithelioid hemangioendothelioma:A case report and review of the literature[J].Am Surg,2008,74(1):64-68.