Analyzing diagnosis and treatment of 45 cases with rare benign hepatic tumor

目的 探讨肝少见肝脏良性占位病变的临床特点,提高对肝脏少见良性占位性病变的认识及临床确诊率.方法 回顾性分析45例肝脏少见良性占位性病变,结合患者的临床资料分析肝少见良性占位性病变治疗经验.结果 B超检查45例,腹部CT检查38例,MRI检查35例,其中B超检出率为42.2％,CT和MR检出率高于B超,分别为60.5％和65.7％,未能检出者均误诊为肝癌或仅诊断肝脏占位性质待定.伴随HBV、HCV及肝硬化17例均被误诊为原发性肝癌或占位性质待查,未检出率100％.45例患者中,3例经肝穿病检证实为局灶性结节增生行定期随访;其余42例均行手术治疗,术后经病理病检确诊,术后康复出院率100％.结论 多种影像学检查可提高肝脏少见良性占位检出率,但确诊有赖于病理检查.并非少见良性占位性病变均需手术切除,但因确诊困难,如何避免不必要的手术是目前临床所面临的难题.     

肝脏占位性病变的术前诊断方法评估

目的 探讨不同肝脏占位性病变的影像学特点和病理诊断结果,以提高肝脏占位性病变术前确诊率的方法.方法 回顾性分析40例患者的临床资料和诊治情况,总结患者术前不同影像学检查中肝脏占位性病变的特征表现,通过对比术后肝脏占位件病变的病理诊断结果,比较B超、动态增强CT和动态增强MRI的术前确诊率. 结果 40例患者均通过手术切除肝脏占位性病变,切除标本中经病理诊断原发肝细胞肝癌22例、肝脏巨大再生结节7例、局灶性结节样增生、胆管细胞肝癌、肝血管瘤和肝硬化结节各2例、肝腺瘤、肝紫癜症和肝内异物反应结节各1例.肝脏B超的确诊率普遍较低,只有20%;增强CT在原发性肝癌和肝脏巨大再生结节的鉴别诊断中准确率较低,分别只有45.8%和0,全部病例的确诊率为42.5%;MRI在各种不典型病变的术前鉴别诊断中确诊率高达92.5%.结论 某些肝脏占位性病变的术前诊断较为困难,应加强对这些病变的认识和鉴别诊断,动态增强MRI对各种肝脏占位性病变的诊断率高.     

肝脏良性实性占位病变误诊分析

目的总结和分析肝脏良性实质性占位病变术前误诊问题,提高临床确诊率.方法回顾性研究我院肝胆胰外科自1998年1月至2004年6月,术前诊为肝癌接受肝切除,术后经病理证实为肝脏良性占位24例患者临床资料.所有病例术前采用统一的诊断方法和步骤,即常规检查血肿瘤标志物,影像学检查（B超、CT、MRI）,少数病例接受肝穿刺活检.结果术前误诊为恶性的24例良性占位中,肝血管瘤9例,肝局灶性结节状增生（focal nodular hyperplasia,FNH）4例,肝腺瘤2例,肝硬化结节性增生2例,肝孤立性坏死结节2例,肝寄生虫性肉芽肿3例,肝结核瘤1例,炎性假瘤1例.术前误诊的原因主要有病灶影像学表现不典型、临床及影像医生认识不足等.24例误诊患者术后发生轻微并发症2例,无需特殊处理;无1例死亡;所有患者经平均3年1个月的随访,无复发病例.结论肝脏良性实质性占位术前易误诊为肝癌.合理地选择联合检查方法和遵循诊治流程,可提高肝脏恶性占位性病变的术前确诊率,减少误诊误治,对术前不能排除恶性的肝脏占位应积极手术治疗.     

肝脏少见良性占位病变的诊断与治疗

目的 为提高肝脏少见良性占位性病变的诊治水平。方法 分析自１９９０年～１９９９年１月经病理让实的肝少见的原发性良性占位性病变１５例（肝腺瘤８例、肝炎性假性瘤１例,肝炎性肉芽肿２例,肝脂肪瘤１例、肝纤维瘤１例）,结合文献对该类肝占位病变的临床特点和诊断治疗进行探讨。结果 肝脏少见占位性病变临床表现无牧民性,术前易误、漏诊,本组１５例病理检查有均误诊为肝癌。结论 Ｂ超引导下多径路肝穿刺活检及剖腹探查可     

罕见肝良恶性占位性病变42例诊断与治疗

目的总结罕见肝良恶性占位性病变的诊治体会,以提高该类疾病的诊治水平。方法回顾性分析42例罕见肝良恶性占位性病变的影像学检查、治疗方法及预后等临床资料。结果术前10例影像学诊断与术后病理诊断一致,诊断准确率为23．8％;B超、CT、磁共振成像（Mill）诊断准确率分别为14．3％、19．4％和22．2％。32例罕见肝良性占位手术切除后无复发,7例罕见肝恶性占位性病变术后2例已分别存活18和36个月,余5例术后平均存活7．5个月。结论罕见肝良恶性占位性病变术前确诊困难,B超、CT、Mill三者联合检测可提高诊断准确率,良性占位性病变术后无复发,恶性占位性病变手术可延长患者生命。     

肝脏占位性病变误诊为原发性肝癌(附34例分析)

自1984年10月至1994年10月,根据临床症状,体征及甲胎蛋白、B超、CT、肝血管造影,提示肝脏占位性病变,但不能鉴别病变性质.拟为原发性肝癌(下简称肝癌)。行手术探查95例,与病理不符,误诊为肝癌者34例,误诊率为35.8％。涉及肝良恶性疾病21种。术前修正诊断8例,修正后误诊率为27.38％。 为减少误诊率,笔者认为除作肝定性、定位及各种辅助诊断检查外,详细询问病史和仔细体查和肝穿刺可排除肝血管瘤、肝脓肿,并作病理活检,可增加诊断的正确性。     

肝细胞腺瘤47例的诊断与外科治疗

目的 总结肝细胞腺瘤(hepatocellular adenoma,HCA)的诊断与外科治疗经验.方法 回顾性分析1989-2009年收治的47例HCA患者的临床资料.结果 本组47例肝细胞腺瘤均为单发病变,术前确诊7例(14.9％),误诊为其他性质的肝占位病变40例(85.1％),最后诊断经术中快速冰冻病理切片或术后病理证实,术前误诊率高达85.1％,其中误诊肝癌11例,肝血管瘤10例,局灶性结节增生14例,肝占位性质待查5例.术前经B超、CT、MRI、DSA等影像检查,只能提示肝占位病变,最后确诊仍需手术探查和病理检查.本组47例HCA均无明确诱因,均采取手术治疗,分别行局部切除、肝段、肝叶或半肝切除术.为预防复发或恶变,切缘距瘤体边缘1.0cm以上.本组术后随访45例,随访率达95.7％,随访6年患者均存活,未见肿瘤复发.结论 HCA临床少见,术前误诊率高,手术切除是HCA惟一有效的治疗方法,预后良好.     

肝脏良性占位病变误诊为肝癌25例分析

目的：探讨肝脏良性占位病变误诊的原因。方法：回顾性分析25例肝脏良性占位病变患者的误诊情况。结果：我院行手术后病理诊断肝脏海绵状血管瘤10例，肝脏脓肿3例，肝脏炎性假瘤3例，肝纤维瘤1例，肝胆管腺瘤1例，肝细胞腺瘤1例，肝局灶性结节增生2例，肝细胞不典型增生4例。结论：肝良性占位病变临床表现多样性，有的病例少见，无特征性，临床医师对它们认识不足，不熟悉，缺乏警惕性，B超，CT医师诱导误诊是主要原因。     

少见的肝脏良性肿瘤

目的　为提高肝脏少见的良性肿瘤的诊治水平。方法　分析 1990～ 1999年经病理证实的肝脏少见的原发性良性肿瘤 11例 (肝腺瘤 8例 ,肝炎性假性瘤 1例 ,肝脂肪瘤 1例 ,肝纤维瘤 1例 ) ,结合文献对该类肿瘤的临床特点和诊断治疗进行探讨。结果　肝脏少见良性肿瘤临床表现无特异性 ,术前易误漏诊。本组 11例病理检查前均误诊为肝癌。结论　B超引导下多径路肝穿刺活检和剖腹探查可确诊肝脏少见良性肿瘤 ,手术是治疗肝脏原发性良性肿瘤的最佳措施。     

多普勒超声与肝动脉DSA联合碘油CT检查诊断微小肝癌及肝良性结节

目的探讨多普勒超声与肝动脉DSA联合碘油CT检查对微小肝癌及肝良性结节的诊断价值。方法回顾性分析100例因临床高度怀疑原发性微小肝癌或肝癌术后复发性微小肝癌而接受多普勒超声及肝动脉DSA联合碘油CT检查的肝硬化患者影像资料,并与病理结果相对照。结果最终经病理诊断为微小肝癌80例共104个病灶,肝良性结节20例共27个病灶。多普勒超声检出微小肝癌病灶90个,检出率86.54%(90/104);检出肝良性结节20个(均为肝硬化结节),检出率74.07%(20/27)。肝动脉DSA联合碘油CT检出微小肝癌病灶96个,检出率92.31%(96/104);检出肝良性病灶6个(其中无肝硬化结节),检出率22.22%(6/27)。与肝动脉DSA联合碘油CT检查相比,多普勒超声对微小肝癌的检出率较低(χ~2=9.58,P0.05),而对肝良性结节的检出率较高(χ~2=10.96,P0.05)。结论多普勒超声对肝硬化良性结节的检出更具优势,而DSA更有利于检出微小肝癌病灶。     

肝脏罕见肿瘤的诊断和治疗

目的 探讨肝脏罕见肿瘤的诊断和治疗方法.方法 回顾性分析我院2005年5月至2010年1月收治的25例肝脏罕见肿瘤患者的临床病理资料.结果 25例患者中肝局灶性结节性增生6例,肝血管平滑肌瘤、肝门部神经鞘瘤、肝左叶动脉瘤、肝胆管囊腺瘤、肝错构瘤、肝胆管绒毛状腺瘤、肝弥漫性大B细胞淋巴瘤各1例,肝血管平滑肌脂肪瘤2例,肝原发间质瘤2例,肝母细胞瘤5例,肝胚胎性肉瘤3例;术前行B超检查24例,CT检查22例,MRI检查6例,仅有3例(16.7%)检查和术后病理结果一致.术前诊断和术后病理符合5例(20%).25例均行手术切除治疗,包括半肝切除术7例,肝叶切除术7例,肝段切除术9例,肿瘤局部挖除2例.肝脏良性、低度恶性肿瘤及1例弥漫性大B细胞淋巴瘤术后无复发,5例恶性肿瘤随访中3例术后复发行再次手术切除,术后随访无复发;另2例死亡,平均术后生存期4个月.结论肝脏罕见肿瘤影像学诊断率低,手术切除是主要的治疗手段,对能切除的复发性肿瘤性病变应争取再次手术切除.     

Benign liver tumors

With widespread use of ultrasonography, fortuitous discovery of benign tumors of the liver raises the question of surgical management in a large number of young subjects. In order to obtain certain diagnosis and determine appropriate management, avoiding unnecessary surgery for asymtomatic tumors with a benign evolution or inversely delaying surgical treatment of malign lesions, the surgeon must be aware of the different features of benign tumors, their expected course, and the capacity of imaging techniques to provide positive diagnosis. Diagnosis: The most frequent benign tumors found in the liver are hemangiomas or angiomas. Lesions measuring less than 3 cm are often fortuitous discoveries at ultrasonography,: a typical homogeneous hyperechogenic zone is sufficient for diagnosis. There are two situations where diagnosis can be difficult: atypical hypoechogenic or large remodeled lesions, hepatopathy in the context of a malignant disease. Certain diagnosis can generally be achieved with MRI. Cystic lesions of the liver are generally biliary cysts. Ultrasonography is the examination of choice and is usually sufficient for diagnosis. In certain cases there is a differential diagnosis with a young hydatid cyst or a cystadenoma although cystadenomas are very rare tumors usually observed in symptomatic middle-aged women. In case of atypical images, cystic or necrotic malignant tumor should also be entertained as a possible diagnosis. Liver cell tumors include adenomas and focal nodular hyperplasia (FNH). Adenomas related to estrogen-progestogen treatment can lead to two potentially fatal complications (intratumor or intraperitonial hemorrhage or more rarely degeneration to hepatocellular carcinoma), justifying systematic resection. FNH is on the contrary ten times more frequent than adenoma; observed independently of hormone replacement therapy, it does not lead to complications and does not require treatment. It is crucial to establish the diagnosis of noninvasive FNH in order to avoid unnecessary surgery. MRI provides 80% and 95% specificity. If the imaging work-up evidences an atypical FNH and/or a non-tumor anomaly, histological proof is needed. As the performance and risk of percutaneous biopsy remain to be assessed, we prefer laparoscopic large needle biopsy with extemporaneous pathology examination. Imaging cannot provide positive diagnosis of adenoma. Treatment: The rule is abstention from surgery for confirmed diagnosis of angioma, biliary cyst or asymptomatic FNH, irrespective of the size. For symptomatic patients, it is essential to establish positive diagnosis initially and determine the relationship between the signs and symptoms and the tumor before deciding on adapted surgery (fenestration, enucleation, hepatectomy). Surgery may be necessary for cystadenomas, adenomas or cases of doubtful diagnosis, keeping in mind the risk of morbidity and mortality associated with hepatic surgery for benign tumors.     

小儿肝脏间叶性错构瘤12例诊治分析

目的回顾性分析12例小儿肝脏间叶性错构瘤(MHL)的临床资料,以提高该病诊断与治疗水平。方法收集1996年1月至2009年12月小儿MHL12例,年龄1～72个月,临床表现主要为腹部包块、腹胀。8例甲胎蛋白(AFP)增高(48.2～9187.2μg/L)。4例患儿术前行超声引导下肿物穿刺活检术,仅有1例考虑为MHL,余3例未获明确诊断。术前有2例患儿因疑为肝母细胞瘤而分别行介入栓塞和化疗。3例行右半肝切除术,3例行肝左外叶切除术,2例行不规则右半肝切除术,2例行肝右三叶切除术,1例行左半肝切除术,1例行肝部分不规则切除术。结果所有患儿术后均恢复顺利,无并发症发生。术后随访7个月～14年,除1例合并胆道闭锁患儿在1岁时死亡、1例患儿带瘤存活外,余10例患儿均状况良好,无肿瘤复发,复查AFP均正常。结论小儿肝脏间叶性错构瘤是一种少见的肝脏良性肿瘤,结合术前AFP、B超、CT和肿物穿刺病理检查有助于诊断。鉴别困难者宜行剖腹探查,以便明确诊断。手术完整切除后预后良好。     

Prostatic cancer in a young adult: a report of 2 cases

Patients younger than 45 years with prostate cancer are rare. Between 1999 and 2002, we studied two cases of prostate cancer in men aged under 45 years. Case 1; a 45-year-old man admitted with the chief complaint of urination disorder. Serum level of prostate-specific antigen (PSA) was 5,000 ng/ml or higher. Transrectal needle biopsy of the prostate revealed moderately differentiated adenocarcinoma. Computed tomography (CT) and bone scan showed para-aorta lymph node metastasis and bone metastasis. Hormone therapy was performed. Case 2; a 37-year-old man admitted with the chief complaint of pollakisuria and sense of residual urine. Serum level of prostate-specific antigen (PSA) was 24 ng/ml. Magnetic resonance imaging (MRI) showed that the prostate tumor invaded the bladder wall. Transrectal needle biopsy revealed poorly differentiated adenocarcinoma. Hormone therapy and radiation therapy were performed. Twenty-one cases reported in Japan in addition to the present cases are reviewed.     

肾上腺偶发瘤66例报告

目的 探讨肾上腺偶发瘤的临床特征和诊治措施.方法 回顾性分析66例肾上腺偶发瘤的临床资料.结果 定位诊断准确率:B超84.3%,CT 100%,MRI 100%;定性诊断准确率:B超30.0%,CT 75.5%,MRI 79.2%;手术60例:皮质腺瘤32例,肾上腺囊肿6例,髓性脂肪瘤5例,嗜铬细胞瘤5例,肾上腺转移性癌3例,皮质癌3例,神经节瘤3例,神经鞘瘤 1例,血肿1例, 肾上腺皮质结节增生1例.结论 肾上腺肿瘤筛查首选B超、CT、MRI,定位诊断准确;定性诊断应综合肿瘤大小、影像学特征、患者年龄及内分泌功能测定.疑诊嗜铬细胞瘤或定性诊断不明需手术时,应按嗜铬细胞瘤行术前准备.     

Renal oncocytoma. Three case reports

Renal oncocytoma represents a rare benign tumor accounted for 3-5% of renal neoplasms. It has been mistaken for and mistabled as granular or dark cell carcinoma. Between 1993 and 1998, 3 women with renal oncocytoma were recognized at formation and underwent radical nephrectomy. Sonography and the CT scan was performed but the Accurate diagnosis was not possible before performing surgery and histologic investigations. The mean Follow-up of 3 patients was 48 month and showed a benign clinical behaviour in all cases.     

脾原发肿瘤的诊断和治疗

目的:总结脾肿瘤诊治的经验。方法:回顾性分析收治的92例脾肿瘤患者的临床病理资料。其中脾良性肿瘤47例(51.09%)，恶性45例(48.91%)。结果:结果92例脾肿瘤术前B超诊断率为85.87%(79/92)，CT鉴别良恶性正确率为91.30%(84/92)。81例行脾切除，7例行肿瘤切除或脾部分切除术，3例行脾囊肿穿刺术，1例活检。恶性肿瘤1,3,5,10年生别率分别为68.29%,31.70%,14.63,0.24%。结论:影像检查是脾肿瘤的主要诊断手段，治疗应以手术为主，良性肿瘤术后无需特殊处理，对瘤体较大、分化较差的恶性肿瘤术后应进行辅助治疗。     

Malignant-like angiomyolipoma of the liver: report of one case and review of the literature

Frequently found in kidney, angiomyolipoma is a rare mesenchymal tumor when diagnosed in the liver and usually benign composed of proliferative blood vessels, fatty tissue and smooth muscle. We report the case of a 67-year-old woman who underwent a left hepatectomy for a 4th segment tumor unidentified after imaging and fine needle biopsy. Final anatomopathologic examination revealed an epithelio?d hepatic angiomyolipoma with signs of malignant behaviour as vascular and lymphatics embolus and invaded left portal vein thrombosis. During the subsequent 24-month follow-up, no recurrence was observed. A review of the literature found only two cases of malignant hepatic angiomyolipoma with fatal issue, however, their incidence must be underrated because of their scarcity and the difficulty of their diagnosis, which needs immunohistochemical confirmation with HMB 45 in particularly. Advances in imaging and anatomopathology in particular with the concept of PEComa (Perivascular-Epithelio?d Cell) as the unifying feature should lead to the recognition of the various variant patterns and cell types. The latter which are important for a correct diagnosis, in order to obtain reliable data about frequency, possible malignant behaviour and therefore consensus management for hepatic angiomyolipoma.     

Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses

PURPOSE: We evaluated the accuracy and clinical role of fine needle percutaneous biopsy of solid renal masses 4.0 cm or smaller with helical computerized tomography (CT) guidance. MATERIALS AND METHODS: In 88 consecutive patients (mean age 61 years) 88 biopsies were performed. Median tumor size was 2.8 cm. Tumor biopsy was performed with an 18 gauge needle using helical CT guidance in an outpatient setting. At least 2 whole cores per tumor were obtained. RESULTS: Biopsy material was insufficient for analysis in 3 (3.4%) procedures. Median tumor size of failed biopsies was 3.0 cm. There were 5 (5.6%) biopsies which revealed fibrosis and were considered inconclusive. A benign lesion was found in 14 (15.9%) biopsies. In the 66 biopsies positive for malignancy there were 65 cases of renal cell carcinoma and 1 lymphoma. A total of 62 patients underwent surgery. Biopsy changed tumor management in 42 (47.8%) patients who avoided radical nephrectomy, 13 of whom had a lesion which did not require surgery, 1 with a lymphoma and 28 who were treated with partial nephrectomy. Biopsy accuracy for histopathological tumor type and Fuhrman nuclear grade was 92% and 69.8%, respectively. No substantial morbidity occurred. CONCLUSIONS: Fine needle biopsy of small renal masses could select benign lesions for which observation might be an alternative to surgery. The accuracy of fine needle biopsy in identifying histological tumor type was high. However, biopsy was less accurate in evaluating Furhman grade. Biopsy with helical CT guidance could be a key point in tailored management of small solid renal masses and provide important information to those patients harboring renal masses.