Misdiagnosis of liver nodule lesions

目的 总结肝脏结节性病变误诊的教训,提高诊断准确率.方法 回顾性总结2008年1月至2012年2月间误诊的12例肝脏结节性病变,所有病人均经穿刺活检或手术确定病理结果.结果 良性病变误诊为肝细胞癌7例(2例为肝脓肿,2例为肝炎性假瘤,1例为局灶性结节样增生,1例为肝硬化结节,1例为血管瘤);肝细胞癌误诊为良性病变4例(3例误诊为肝脓肿,1例误诊为局灶性结节样增生);另1例肝细胞腺瘤误诊为局灶性结节样增生.结论 肝脏结节性病变的诊断应结合病人的病史、临床表现、化验、影像学检查及病理结果综合分析.     

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肝局灶性结节性增生 (ｆｏｃａｌｎｏｄｕｌａｒｈｙｐｅｒｐｌａｓｉａ ,ＦＮＨ)是一种肝脏良性病变 ,多无临床症状。因易与肝细胞腺瘤、高分化肝细胞癌及肝结节性再生性增生等肝占位病变混淆而倍受重视 ,国内报道很少 ,本文回顾性分析我院 1996～2 0 0 0年收治的 6例ＦＮＨ临床资料 ,探讨ＦＮＨ合理的诊治方案。1　临床资料本组男 4例 ,女 2例。年龄 2 5～ 45岁 ,平均 34 7岁。6例病人均无临床症状 ,影像学检查发现 4例 ,术中探查发现 1例 ,查体时触及上腹包块 1例。既往均无肝炎、肝硬化病史 ,无恶性肿瘤病史 ,无类固醇激素和口服避孕药…     

局部消融在肝脏微小占位病变治疗中的地位及评价

随着影像学技术的发展，肝脏微小占位病变的临床诊断已不再困难，其治疗比较特殊。 从病理上来说，非肝硬化中的肝细胞结节性病变主要包括：肝细胞腺瘤（liver cell adenoma，LCA），局灶结节性增生（focal nodular hyperplasia，FNH），大再生性结节（large regenerative nodule，LRN），结节再生性增生（nodular regenerative hyperplasia，NRH），部分结节转化（partial nodular transformation，PNT），代偿性增生（compensatory hyperplasia），灶状脂肪变性（focal fatty change）和肝细胞癌（hepatocellular carcinoma，HCC）。从临床上来说，肝脏常见微小占位病变主要有小肝癌（small hepatocellular carcinoma，sHCC），微小肝癌（micro hepatocellular carcinoma，mHCC）及相关结节，小转移瘤、小血管瘤、小囊肿、小的其他良性占位病变等。     

肝硬化性血管瘤与肝其它肿瘤的影像学表现差异

目的比较分析肝硬化性血管瘤与肝海绵状血管瘤、肝细胞癌、肝胆管细胞癌及转移性肝癌的影像学表现差异,提高对该病的认识及术前诊断水平。方法收集并分析自2000～2008年上海东方肝胆外科医院经手术病理证实的10例肝硬化性血管瘤的临床影像学资料包括CT、MRI表现。结果本组肝硬化性血管瘤缺乏肝海绵状血管瘤的典型CT及MRI特征：CT增强动态扫描显示肿瘤动脉期、门脉期均无明显强化,延时扫描病灶强化较为明显;MRI T1加权像病灶为低信号,1、2加权像病灶表现为由多种信号组成,部分病灶呈高信号。其中3例误诊为肝细胞癌,2例误诊为胆管细胞癌,1例误诊为胆管细胞癌合并感染,1例误诊为肝转移瘤,1例误诊为肝脓肿,1例误诊为非典型性海绵状血管瘤,1例误诊为后腹膜肿瘤。结论认识肝硬化性血管瘤的影像学表现,对于提高该病的认识和术前诊断水平,避免不必要的手术具有重要意义。     

肝脏占位性病变

病史摘要 患者男性,48岁,于1995年3月体检时B超发现“肝右叶占位性病变”,遂于当地医院行CT、MRT检查,均提示“肝海绵状血管瘤”。5月在该院行肝动脉栓塞化疗。7月行剖腹探查术,术中见:肝呈结节样变,肿瘤质地较软、界限不清,切除困难,考虑为“血管瘤”,仅行肝动脉结扎,术后恢     

肝脏外科少见病诊治问题

肝脏外科少见病是指发生于肝脏并排除了肝细胞癌和胆管细胞癌以及肝囊肿、肝海绵状血管瘤等常见良性占位之后的其它一些发生率较低的良恶性肿瘤和瘤样病变，其组织学类型复杂，临床上常无典型症状，实验室检查亦缺少特异性指标，诊断主要依靠影像学检查和病理检查。由于肝脏不同组织学类型的肿瘤预后相差悬殊，因此，术前定性诊断对治疗方案的选择以及病人的预后尤为重要。本文概述几种临床相对多见的病变，并根据其特点探讨诊治要点。     

肝移植术后肝动脉栓塞介入溶栓术1例

患者，男，41岁，主诉：乏力、纳差2个月，实验室乙肝七项检查，大三阳，B超，肝硬化，肝右后叶可疑实性占位性病变，入院后CT增强扫描，原发性肝癌、弥漫型伴门脉癌栓、肝硬化、腹水，一周后行肝固有动脉化疗栓塞术治疗肝癌同时准备肝移植。介入治疗后32天进行肝移植术，术后3天生命体征平稳，B超示肝动脉血流正常。术后第四天B超未见肝动脉正常血流，1h后复查仍未见肝动脉血流，急诊进行肝动脉DSA。     

肝脏良性占位病变的诊断和外科治疗

肝脏良性占位性病变约占肝脏病的10%,主要有以下几种:肝血管瘤、肝腺瘤、局灶性结节性增生、炎性假瘤和肝囊肿等,其它的良性占位性病变较少见。迄今为止,对于良性肝肿瘤仍无血清学可靠的诊断标志物,因此,如何提高肿脏良性肿瘤的定性诊断率,并根据不同的病因进行治疗是对普外科医生具有挑战性的任务。1　肝脏良性肿瘤1.1　肝血管瘤肝血管瘤是肝脏最常见的良性肿瘤,其发生率为2%～7%。肝血管瘤通常系指海绵状血管瘤,无包膜,切面呈海绵状,大的病灶中央可有瘢痕组织。B超是诊断肝血管瘤的常用方法,直径<3.0cm的肝血管瘤多表现为边界清楚的高回…     

肝局灶性结节性增生一例

患者 ,男 ,32岁 ,体检中Ｂ型超声无意发现肝右叶占位性病变于 2 0 0 0年 6月 8日入我院。既往无肝炎 ,肝硬化病史。入院后检查 ,肝功能及甲胎蛋白均正常 ,ＣＴ片示肝右叶占位病变 (图 3) ,入院诊断肝右叶肝癌 ,限期手术。术中见 :肝右前叶包膜下直径约 2ｃｍ结节性肿物 ,行肝肿物切除术。病理学检查 :部分切除的肝组织 ,切面见肝包膜下有一 2 3ｃｍ×2 0ｃｍ× 2 0ｃｍ的结节状病灶 ,境界清楚 ,颜色较周围肝组织略浅 ,结节内可见纤维条索将病变分隔成多个小结节。光学显微镜检查显示 :肝结节主要由排列成索状的成熟肝细胞构图 1,2　光学…     

CT MRI及PET对肝脏微小占位性病变的诊断价值

肝脏占位性病变的诊断和鉴别诊断一直是研究的重点，这些占位性病变包括原发性肝癌（以下简称肝癌）、转移性肝癌、肝血管瘤、局灶性结节增生、腺瘤以及肝囊肿等。包括CT、MRI及PET或PET／CT（正电子发射计算机断层显像／X线计算机体层成像）在内的影像学检查是较为重要的检查手段，能检查出大部分肝脏占位性病变，但对于直径〈3cm的微小占位病变，由于其功能及组织结构的特殊性，往往在诊断或鉴别诊断上仍存在较大的困难。     

Partial nodular transformation in a cirrhotic liver

We present a case of partial nodular transformation (PNT) of the liver in a 57-year-old man with a history of heavy drinking. On computed tomography, a low-density mass, measuring 3 cm in diameter, and associated with portal flow defect was visualized. Based on this finding and on the findings of other imaging studies, hepatic resection was performed because of suspected hepatocellular carcinoma. Pathology examination of the excised specimen showed small portal tracts in the lesion. The findings for the rest of the liver were suggestive of mild liver cirrhosis. While PNT is similar to nodular regenerative hyperplasia (NRH), in NRH there is diffuse nodular transformation of the whole liver, whereas in PNT only the area adjacent to the porta hepatis is affected. The portal flow defect in PNT may be the result of attenuation of the portal tracts in the lesion. This case is of interest because there was only one PNT lesion, rather than multiple lesions, and because it occurred in a cirrhotic liver, thus giving rise to the suspicion of hepatocellular carcinoma. PNT is a benign disorder, thus it is essential to establish a definitive diagnosis by imaging and ultrasound-guided histological biopsy to prevent unnecessary hepatic resection.     

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.     

肝脏血管平滑肌脂肪瘤诊断与外科治疗：附19例报告

背景与目的 肝脏血管平滑肌脂肪瘤（HAML）是肝脏少见的一种间叶组织来源的良性肿瘤,影像学检查缺乏特异性,术前诊断率低,容易误诊为肝细胞癌或其他肝良性肿瘤,本文报告19例HAML患者的诊治过程,以期为临床提供参考和借鉴。方法 回顾性分析2011年1月—2019年12月收治的19例HAML患者临床资料,其中女12例,男7例;年龄28~61岁;体检发现无临床症状者14例,表现为上腹部隐痛者3例,间断腹胀者1例,腹痛伴腹泻者1例;1例合并慢性乙型病毒性肝炎及肺脓肿,1例合并乙型肝炎肝硬化代偿期。19例均不伴肾肺等其他脏器血管平滑肌脂肪瘤,均无结节性硬化症。肿瘤直径1.3~12 cm,平均直径（4.6±2.2）cm。AFP、CA19-9、CEA均正常。7例患者术前诊断肝细胞癌（36.8%）,12例术前诊断肝良性肿瘤（63.2%）,分别为7例诊断肝腺瘤,2例诊断炎性假瘤,1例诊断肝海绵状血管瘤,1例诊断肝局灶性结节性增生,1例术前行超声引导下肝脏穿刺活检病理证实HAML。结果 患者均行外科手术治疗,18例行肝切除治疗,1例行超声引导下肝肿瘤穿刺活检术、经皮穿刺肝肿瘤射频消融术。平均手术时间（172.7±80.4）min,术中平均出血量为（456.6±528.1）mL,平均术后住院时间（9.8±2.7）d。19例患者病理检查均证实HAML,其中7例为上皮样血管平滑肌脂肪瘤,免疫组化检查HMB-45、SMA均阳性表达。患者术后恢复良好,所有患者无肝衰竭、腹腔出血、胆汁漏等并发症发生,无死亡病例。全部病例均获随访,均未发现肿瘤复发及转移。术后患者有良好的生活质量。结论 HAML瘤属于良性肿瘤,术前诊断比较困难,一部分患者容易误诊为肝细胞癌,最终诊断依靠病理及免疫组织化学染色,外科手术切除是安全、有效的治疗选择,预后良好。     

Nodular regenerative hyperplasia: a controversial indication for orthotopic liver transplantation

Nodular regenerative hyperplasia of the liver is an uncommon cause of portal hypertension. Patients with nodular regenerative hyperplasia have signs and symptoms of portal hypertension, without evidence of hepatocellular failure or encephalopathy. We report the case of a 44-year-old woman with recurrent esophageal bleeding and refractory ascites who had a history of hemosiderosis, hepatitis C, and chronic renal allograft rejection. Our preoperative diagnosis was cirrhotic end-stage liver disease and end-stage renal disease for which the patient underwent combined hepatic and renal transplantation. Her portal hypertension symptoms resolved, and her renal function has been normal for 18 months of follow-up. Histologic examination of the liver revealed nodular regenerative hyperplasia, and a review of the literature regarding the surgical management of patients with nodular regenerative hyperplasia revealed that various shunting procedures are generally recommended. After the failure of medical management in patients with nodular regenerative hyperplasia, portosystemic shunting may be indicated before proceeding to hepatic transplantation.     

Adult Capillary Hemangioma of the Liver: Report of a Case

We report a rare case of capillary hemangioma of the liver in an adult. The patient was a 55-year-old man, admitted for investigation of a hepatic tumor. The tumor was seen as a hypoechoic mass with a peripheral hypoechoic ring on ultrasonography. Computed tomography (CT) showed an enhancement pattern different from that of hepatocellular carcinoma (HCC) or cavernous hemangioma. Ultrasonography-guided biopsy was technically very difficult because the tumor was located just below the diaphragm. We could not establish whether the tumor was HCC or cavernous hemangioma by the imaging findings, so we performed a hepatic resection. Histopathological examination confirmed a diagnosis of capillary hemangioma. Ultrasonography, CT, and magnetic resonance imaging showed an intermediate pattern between cavernous hemangioma and HCC. Thus, we must be aware of the possibility of capillary hemangioma when finding an atypical liver tumor inconsistent with HCC or cavernous hemangioma.     

超声造影对肝脏局灶性病变误诊分析

目的 探讨肝脏局灶性病变的CEUS误诊原因.方法 回顾性分析与病理结果不符的40例肝脏病变的CEUS特征,分析其误诊原因.结果 40例CEUS误诊病例中,14例病理诊断为肝细胞性肝癌(HCC),其中4例误诊为局灶性结节增生,3例误诊为血管瘤,4例误诊为肝硬化结节,1例误诊为肝脓肿,2例误诊为良性病变,其中1例肝转移性腺癌,误诊为炎性病灶;1例胆管细胞癌误诊为良性病变.24例病理诊断为良性病灶,其中21例CEUS误诊为恶性肿瘤,3例误诊为其他良性病变.结论 加深对肝脏病变病理、组织形态特点的理解,仔细观察CEUS图像特征,紧密结合临床,可提高CEUS对肝脏病变的诊断正确率.     

肝结节性再生性增生18例诊治分析

目的 分析总结肝结节性再生性增生(nodular regenerative hyperplasia of the liver,NRH)的临床诊治经验,以提高临床医师对本病的认识.方法 回顾性分析我院近26年连续收治的18例:NRH的临床表现、影像学及实验室检查、诊治及预后资料.结果 本组18例NRH患者中有15例表现为门静脉高压,4例表现为肝脏单发、多发占位,8例合并自身免疫疾病,3例可疑合并血液系统疾病.本组患者中术前13例被诊断为肝硬化,2例诊断为肝癌或局灶性结节性增生(focal nodular hyperplasia FNH).所有18例患者均行肝楔形活检,并且3例行脾切除,4例行断流术/Phemister术,3例行肝占位/肝叶切除术,1例行部分小肠切除术,1例行脾动脉缩窄限流手术.术后门静脉高压症状明显缓解.随访多数患者症状稳定,说明肝脏占位的:NRH患者预后良好.结论 NRH可能与肝脏血供紊乱有关,临床最常表现为门静脉高压,并可伴发免疫、血液系统性疾病.临床表现为单发、或多发性肝脏占位,应注意与肝硬化、局灶性结节性增生、特发性门静脉高压等鉴别,诊断依靠肝楔形活检.手术对于治疗门静脉高压疗效确切.

Abstract：

Objective To summarize the clinical diagnosis and treatment of nodular regenerative hyperplasia of the liver. Methods Retrospective analysis was made on the clinical manifestations,imagings, laboratory tests, diagnosis, treatment and prognosis of 18 consecutive cases finally established as NRH during the past 26 years. Results 15 of the 18 cases showed portal hypertension, 4 cases showed mono or multiple occupations of the liver, 8 cases suffered from concurrent autoimmune diseases, 3 cases were suspected of blood diseases. Preoperatively, 13 cases were diagnosed as cirrhosis, 2 cases were diagnosed as liver cancer or focal nodular hyperplasia ( FNH). All cases were diagnosed by operative wedging biopsy. 3 cases received splenectomy, 4 cases received disconnection /Phemister surgery, 3 cases received liver occupation/liver lobe resection, 1 case received partial small bowel resection, and 1 case received spleen artery restrictive surgery. Postoperatively, symptoms of portal hypertension relieved obviously. Follow-up study showed most of the patients were stable and prognosis of the NRH was good.Conclusions NRH may relate to the disturbance of liver blood supply, and most common clinical manifestation is portal hypertension, and can combine with immune diseases, hematopathy also can present single or multiple liver occupations. Differential diagnoses include liver cirrhosis, FNH, idiopathic portal hypertension. Diagnosis of NRH relies on liver wedging biopsy. Surgery can relive concurrent portal hypertension.     

肝脏血管周上皮样细胞瘤38例临床诊治分析

背景与目的：肝脏血管周上皮样细胞瘤（PEComa）是一种少见的肝脏原发性肿瘤,由于缺乏特异性的症状及影像特征,容易误诊为肝细胞癌、肝血管瘤,影响临床治疗。为探索肝脏PEComa的疾病特点及诊治方法,本研究通过总结我院既往收治的肝脏PEComa患者临床病理资料,对其临床诊疗和预后进行分析,旨在提高对该疾病的诊疗水平。方法：回顾2010年7月—2021年6月期间中南大学湘雅医院普通外科收治的38例肝脏PEComa患者的临床病理资料,对患者的临床特点、影像学表现、病理特点、治疗及预后并进行分析。结果：38例患者中,女性28例（73.7%）,男性10例（26.3%）,中位年龄46 (21～66)岁。38例患者共发现40个肝脏结节,结节的大小1.0～20.0 cm,平均（6.02±4.84） cm,其中位于右肝21个（52.5%）,位于左肝17个（42.5%）,位于尾状叶2个（5%）。10例患者有临床症状,表现为腹胀和腹痛或寒战和发热。35例患者行术前肝脏彩超检查,病灶表现为高回声（18例）、混合回声（12例）或低回声（5例）肿块。23例患者术前行增强CT检查,增强后动脉期均出现明显增强,19例...     

Benign hepatic masses mimicking metastatic renal cell carcinoma

Making the distinction between a benign hepatic mass and renal cell carcinoma metastatic to the liver is crucial in evaluating a patient with renal cell carcinoma. The erroneous diagnosis of metastatic renal cell carcinoma may deter the surgeon from performing a potentially curative nephrectomy. In this report, we present 1 patient with cavernous hemangiomas and another patient with focal nodular hyperplasia of the liver. In each case the benign liver lesion was incorrectly diagnosed initially as metastatic renal cell carcinoma. The radiographic appearance of these lesions is discussed in detail.     

尾状叶巨大海绵状血管瘤的外科处理

目的：探讨肝尾状叶巨大海绵状血管瘤的外科处理策略。 方法：回顾性分析4例肝尾状叶巨大海绵状血管瘤患者的临床治疗资料。 结果：术前将患者Child-Pugh评分均调整至A级,CT及三维立体重建检查,了解肿瘤与肝动、静脉及门静脉的关系;2例患者依照左右路径+前路劈肝路径切除,另2例行左半肝+尾状叶联合切除。患者均安全顺利地实行了肝尾状叶巨大血管瘤切除术,术后无严重并发症的发生。 结论：术前充分评估,术中精细操作,手术治疗肝尾状叶巨大血管瘤可取得满意疗效。