肝脏少见恶性肿瘤的CT表现

目的 分析5例不同组织类型的肝脏少见恶性肿瘤的CT表现，以提高对这些恶性肿瘤的识别能力。方法 经临床和病理证实的肝脏少见恶性肿瘤5例，均行CT检查，其中肝肉瘤3例(包括血管肉瘤1例，恶性间叶瘤1例，恶性纤维组织细胞瘤1例，类癌2例)。结果 上述肝脏恶性肿瘤表现多样化，恶性间叶瘤以儿童肝内巨大单发囊性为主病灶；肝血管肉瘤表现为肝内多发境界清楚的低密度灶，可合并坏死、囊变及新鲜出血，无肝硬化基础；恶性纤维组织细胞瘤为肝右叶单发巨块低密度病灶，可伴纤维分隔，免疫组织化学标记具有诊断价值；类癌CT特征为肝内单发或多发病灶，密度不均匀，呈单房或多房，增强表现实质部分强化，伴类癌综合征时更具有诊断价值。结论 本组分析的5例肝脏恶性肿瘤临床均较少见，各种病理类型的此类肿瘤有其相似和不同的CT征象，结合临床及实验室检查，应在临床诊断中考虑到上述肿瘤的可能，以免漏诊或误诊。

CT findings of uncommon malignant tumors of the liver

Objective To improve the diagnostic level of uncommon hepatic malignancy in 5 cases with different histopathological nature by analyzing their CT features. Methods CT scan was performed in 5 cases with pathologically proved uncommon malignancy of the liver including hepatic sarcoma ( n =3) and primary carcinoid tumor ( n =2). Results These uncommon malignancies of the liver had a variety of presentations. Undifferentiated embryonal sarcoma presented as a single huge cyst mixing with solid mass. Hepatic angiosarcoma demonstrated as multiple well defined hypoattenuation lesions without cirrhosis. Necrosis, cystic degeneration, and hemorrhage may be accompanied. Malignant fibrous histiocytoma displayed as a single large hypoattenuation lesion within hyperdense septations, and most of the tumor was in the right lobe. Immunohistochemistry had the diagnostic value. The CT features of carcinoid tumor were single or multiple, unilocular or multilocular mixed dense masses. The solid portion of the masses enhanced obviously and carcinoid syndrome may highly suggest the diagnosis. Conclusion The forementioned 5 cases of hepatic malignancy are seldomly seen clinically. Each of them with different pathologic nature has different CT findings, and sometimes with some similar signs. Typical CT findings, coupled with clinical information may lead to a correct diagnosis.