肝内肿块型胆管细胞癌不典型犆犜表现与病理对照分析

目的：肝内肿块型胆管细胞癌（intrahepatic peripheral cholangiocarcinoma，IHPCC）不典型 CT 表现易引起误诊或漏诊，本研究以病理学为基础，探讨其不典型 CT 表现，并结合相关文献分析，提高术前诊断准确性。方法回顾性分析2006-06-01—2014-06-30广西医科大学附属肿瘤医院经术后病理确诊的20例 IHPCC 患者平扫及增强各期表现，与病理学结果进行对照分析。结果20例 IHPCC，13例为单一病灶，7例为多发病灶；14例平扫呈低密度，6例呈等或稍高密度；肿瘤最大径1．8～11．4 cm。根据平扫动态强化不典型表现分 A、B 和 C 组。A 组3例病灶呈“快进快出”表现，未见明确胆管扩张及肝包膜皱缩；病理上肿瘤实质细胞较多，纤维组织成分较少。B 组12例病灶呈“延迟强化”表现，未见明确胆管结石及胆管扩张；病理上肿瘤周边实质细胞丰富，中央以纤维组织为主。C 组5例病灶呈“轻度强化”表现，周围局部胆管轻度扩张；病理上肿瘤周边细胞偏少，中央坏死液化组织较多。结论IHPCC 不典型 CT 表现有赖于病理学基础，仔细分析有助于提高诊断与鉴别诊断水平。

Liver tumor cholangiocarcinoma atypical manifestations and pathological basis of CT

OBJECTIVE The atypical findings of intrahepatic cholangiocarcinoma tumor intrahepatic peripheral cholangiocarcinoma (IHPCC)can lead to misdiagnosis or missed diagnosis,this paper discusses the relationship of atypical CT findings and clinical pathology to improve the preoperative diagnosis accuracy.METHODS Twenty patients with pa-thology in our hospital were enrolled IHPCC from June 1,2006 to June 30,2014 in this study,CT findings were retrospec-tively analyzed.The relevant literatures were reviewed.RESULTS Of 20 cases IHPCC,13 cases showed single lesion and 7 cases of multiple lesions.Fourteen cases showed low density and 6 cases showed equal or slightly higher density. Maximum tumor diameter was about 1.8-11.4 cm.A-C groups were shown on basis of dynamic enhanced atypical ap-pearances.Group A:3 cases lesions were “fast in and fast out”appearance,no clear bile duct dilatation liver capsule shrinkage.The Pathological results characterized by more tumor cell and less fibrous tissue.Group B:12 lesions ap-peared “delayed enhancement”,no clear bile duct stones and bile duct dilatation.The pathological results characterized by more tumor cells surrounding parenchymal,central to the fibrous tissue based.Group C:5 lesions were presented “slightly enhanced”appearance,around the local duct mild expansion,The pathological results characterized by less normal cells surrounding parenchymal,more central necrotic tissue liquefaction.CONCLUSION liver tumor cholangiocarcinoma atypical CT manifesta-tions depends on pathological basis,careful analysis can help to improve the diagnosis and differential diagnosis.