肝脏巨大血管平滑肌脂肪瘤1例报告并文献复习

正1病例资料患者女性,20岁,因"间断腹部不适1年"入院。查体:皮肤、巩膜无黄染,未见肝掌、蜘蛛痣,全身浅表淋巴结未触及肿大,双侧肺呼吸音清,心律齐,全腹可触及弥漫性肿块,大小约18 cm×10 cm,质中,活动度差,无压痛,双下肢无水肿。腹部彩超:上腹部见实性低回声区,形态欠规则,边界与网膜分界欠清,范围164 mm×90 mm。彩色多普勒血流显像(color Dppler     

肝血管平滑肌脂肪瘤一例报道

肝血管平滑肌脂肪瘤属罕见肿瘤,到1993年为止国外文献报道仅36例,国内尚未见报道。我院通过B超、CT、病理检查及手术,诊疗了一例肝血管平滑肌脂肪瘤,报道如下。 临床资料 彭某,男,50岁,因右上腹隐痛不适,自己扪     

肝血管平滑肌脂肪瘤一例

患者男 ,6 8岁。 1991年体检时Ｂ超发现左肝有一直径 2ｃｍ的肿块 ,诊断为“血管瘤” ,无不适 ,亦未经任何治疗。1999年因胸背部带状疱疹复查Ｂ超 ,左肝示 7.6ｃｍ× 7ｃｍ× 8.1ｃｍ强光团 ,界尚清 ,内部略不均匀 ,印象为左肝血管瘤。ＣＴ检查发现左肝内侧段有 6 .9ｃｍ× 6 .7ｃｍ肿块 ,表面隆起 ,其内密度不均 (3.3～ 5 1Ｈｕ) ,强化至 83Ｈｕ ,动脉期病灶内可见较粗条状血管影 ,边缘灶强化 ,界较清。因ＣＴ印象首先考虑血管平滑肌脂肪瘤 ,于 1999年 9月 13日住院行左肝肿块切除术。体检 :体温 37°Ｃ、脉搏 80次 /ｍｉｎ、呼吸 2 0次 /…     

肝血管平滑肌脂肪瘤2例报告

肝脏血管平滑肌脂肪瘤（Hepatic angiomyolipoma，HAML）属少见病，我院2003-04／2005-04收治2例，现复习文献报告如下。     

肝血管平滑肌脂肪瘤1例报告

正肝血管平滑肌脂肪瘤(hepatic angiomyolipoma,AML)是临床上一种少见的良性间叶性肿瘤,由Ishak于1976年首次报道~([1]),国内报道始见于1992年~([2,3])。长期以来,虽然AML一直被认为是良性病变,但近些年来有学者提出该病也存在     

肾血管平滑肌脂肪瘤误诊的影像学分析(附6例报告)

肾血管平滑肌脂肪瘤(RAML)是临床较常见的肾脏良性肿瘤，由于其临床表现有时与肾细胞癌(RCC)不易鉴别．故二者易相互误诊。1998～2003年，我院收治RAML患者22例，其中误诊6例。现报告如下。     

肝血管平滑肌脂肪瘤的临床病理学研究进展

肝脏血管平滑肌脂肪瘤(HAML)是发生于肝脏的一种间叶源性肿瘤,根据东方肝胆外科医院病理科档案库资料显示,从2001年1月至2011年10月,经手术切除HAML例数已经超过肝细胞腺瘤.HAML常累及中青年女性,临床无特殊症状和体征,发病隐匿,因缺乏特异性血清诊断标志物,术前确诊率低,主要依靠病理检查明确诊断.HAML的组织和细胞学类型多样,可有“侵润性边界”,特别需要与肝细胞癌等鉴别,文献中已有HAML恶变的报道,分子生物学特征尚待研究.HAML双重表达黑色素细胞和平滑肌细胞标志物,是明确诊断的重要依据.     

肝血管瘤、肝细胞癌和肝血管平滑肌脂肪瘤超声造影特点观察*

目的 探讨肝血管瘤(HCH)、肝细胞癌(HCC)和肝血管平滑肌脂肪瘤(HAML)患者肝内病灶超声造影特点。方法 2017年11月～2020年11月我院诊治的肝占位病变患者112例,所有患者入院后均在治疗前接受常规超声和超声造影检查,观察肝内病灶数目、大小、边界、回声、形态、血供等信息,同时观察超声造影检查过程中动脉期、门静脉期和延迟期病灶的增强模式。结果 经组织病理学检查诊断为HCH患者39例,HCC患者64例和HMAL患者9例;HCH患者女性占比为66.7%,显著高于HCC或HAML患者(分别为18.8%和33.3%,P＜0.05),HCC患者年龄为(57.5±5.8)岁,HMAL患者年龄为(55.3±5.1)岁,均显著大于HCH患者【(46.2±5.2)岁,P<0.05】,HCC患者存在HBV感染发生率为76.6%,显著高于HMAL患者的28.6%或HCH患者的12.8%(P<0.05);在普通超声检查,HCC病灶边界不清、实质呈低回声和混合回声占比分别为65.6%、43.8%和42.2%,显著高于HCH病灶的2.6%、10.3%和7.7%或HAML病灶的0.0%、11.1%和11.1%(P＜0.05),HCH、HCC和HAML患者肝内病灶数目、病灶大小、形态和血供比较,差异无统计学意义(P＞0.05);在超声造影检查方面,HCH病灶在动脉期呈高增强占比为92.3%,显著高于HCC病灶的87.5%或HMAL病灶的88.9%(P＜0.05),HCC病灶门静脉期和延迟期呈低增强占比分别为65.6%和90.6%,显著高于HCH病灶的5.1%和43.6%或HMAL病灶的11.1%和22.2%(P＜0.05)。结论 HAML、HCH和HCC病灶在超声检查方面各具特点,而超声造影检查更具诊断和鉴别诊断价值,值得进一步研究。     

肝细胞生长因子受体在血管平滑肌细胞增殖凋亡中的表达

目的研究球囊扩张术后血管平滑肌细胞(VSMCs)中肝细胞生长因子(HGF)及其受体(c-Met)mRNA表达的变化,明确HGF受体与VSMCs增殖凋亡分子机制的相关性。方法用逆转录聚合酶链式反应检测36只兔腹主动脉球囊损伤前后不同时间点VSMCs中c-Met的mRNA表达水平;体外实验将选择性c-Met蛋白抑制剂NK-4作用于免VSMCs,运用MTF分别于0、24、48及72h检测细胞增殖状态;流式细胞仪观察NK-4对细胞凋亡的影响,进一步采用Western blot检测药物作用前后细胞周期蛋白(Cyclin D1)、凋亡蛋白(Bcl-2)的表达。结果球囊损伤后VSMCs c-Met mRNA的表达水平明显高于正常VSMCs(P＜0．01),平均为对照组2．42倍;对照组S及G_2/M期DNA百分含量与处理组比值分别为1．31,1．62(P＜0．01),NK-4呈时间、剂量依赖性方式抑制VSMCs增殖,促进其凋亡。72h时对照组与NK-4(1．0mg/L)处理组Cyclin D1、Bcl-2表达水平比值分别为2．37和3．81(P＜0．01),故两者表达水平随NK-4作用时间延长而下降。结论c-Met在球囊扩张术后血管平滑肌细胞中高表达可能在VSMCs过度增殖、凋亡受阻中起重要作用。选择性c-Met蛋白抑制剂NK-4可能通过Cyclin D1,Bcl-2影响VSMCs的增殖与凋亡,提示c-Met抑制剂可作为预防血管成形术后再狭窄新的候选药物。     

肝血管平滑肌脂肪瘤1例报道

血管平滑肌脂肪瘤(Angiomyolipoma,AML)为少见病,多见于肾脏,发生在肝脏者罕见且成分复杂,术前诊断困难,因此,误诊率较高.作者通过1例较典型的肝血管平滑肌脂肪瘤完整病例的介绍及相关文献复习,以期提高对肝血管平滑肌脂肪瘤的认识及诊断水平.     

肝上皮样血管平滑肌脂肪瘤2例

目的:探讨肝上皮样血管平滑肌脂肪瘤的病理诊断及鉴别诊断.方法:收集武钢总医院病理科2007-2009年手术切除肝上皮样血管平滑肌脂肪瘤标本2例,对2例肝上皮样血管平滑肌脂肪瘤相关临床资料、病理学特征及免疫组织化学进行观察分析并复习相关文献.结果:2病例均为女性,巨检境界较清楚,镜下见肿瘤主要由弥漫的上皮样细胞构成,排列...     

Hepatic angiomyolipoma pre-operatively diagnosed by imaging

An asymptomatic patient with pre-operatively diagnosed solitary angiomyolipoma is reported. The tumour was a well defined, fat density mass on computerized tomography (CT) and magnetic resonance imaging (MRI), and a hyperechoic nodule with a sharp margin on ultrasonography (US). The lesion was hypervascular on arteriography and CT during hepatic angiography. Chemical shift MRI confirmed the fat component within the lesion. Although a review of the literature shows this tumour to be rare and difficult to differentiate from a malignant lesion pre-operatively, the pre-operative diagnosis of angiomyolipoma is considered feasible when the characteristic findings as described here are present.     

罕见乏脂纵隔血管平滑肌脂肪瘤1例并文献复习

目的探讨乏脂纵隔血管平滑肌脂肪瘤的临床、病理特征和鉴别诊断。方法1例纵隔乏脂血管平滑肌脂肪瘤,同时结合国内外文献复习。结果1例46岁术前诊断为纵隔肿瘤,全麻下行纵隔肿瘤切除术。术后诊断为纵隔乏脂血管平滑肌脂肪瘤,组织学特征与其他部位血管平滑肌脂肪瘤相似,免疫组化表达HMB45、S-100、Des。结论本例罕见,诊断依靠临床、病理学特征及免疫组化三方面结合。乏脂纵隔血管平滑肌脂肪瘤必须经过全面思维和细致检查,以求正确诊断,为决策正确治疗提供科学依据。     

A retrospective study on the clinical and pathological features of hepatic sarcomatoid carcinoma: Fourteen cases of a rare tumor

Hepatic sarcomatoid carcinoma is a rare liver malignancy with atypical clinical symptoms and a high degree of malignancy. To improve the understanding of this disease, we collected the clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma admitted to the First Affiliated Hospital and Second Affiliated Hospital of Bengbu Medical College from 2011 to 2021 and reviewed the relevant literature.The clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma were collected from the electronic medical record system of the 2 hospitals. All clinical data were independently reviewed by 2 clinicians, and all pathological data were independently reviewed by 2 pathologists. At the same time, we reviewed the related literature on hepatic sarcomatoid carcinoma in Pubmed and CNKI.This group of 14 patients, 10 males and 4 females, aged 50–77 years. The main symptoms of the patients were abdominal pain, bloating, anorexia, fatigue or weight loss in the upper abdomen, and 3 patients were asymptomatic. On imaging, hepatic sarcomatoid carcinoma manifests as heterogeneous mass with irregular shape and unclear boundary, and computed tomography (CT)/magnetic resonance imaging (MRI) enhanced scan shows progressive or persistent heterogeneous enhancement, marginal enhancement or annular enhancement, and central necrosis. The pathological features of hepatic sarcomatoid carcinoma are the proliferation of spindle cells and pleomorphic cells, which alternate with acinar cells.Hepatic sarcomatoid carcinoma is more common in middle-aged and elderly patients, especially men, and has no characteristic clinical manifestations. Imaging examination and B-ultrasound-guided liver biopsy + immunohistochemistry can help diagnose. Radical surgery is the preferred method for hepatic sarcomatoid carcinoma, and postoperative adjuvant chemotherapy is expected to prolong patient survival.     

Primary esophageal adenosquamous carcinoma: a retrospective analysis of 24 cases

Primary adenosquamous carcinoma (ASC) of the esophagus is a rare kind of malignancy characterized by mixed glandular and squamous differentiation as well as a propensity for aggressive clinical behavior. Data on the evaluation of the clinicopathological features and the prognosis of patients suffering from this malignancy are few because of the rarity of this disease. We conducted a retrospective review of 24 patients with primary esophageal ASC among 6546 esophageal cancer patients who underwent transthoracic esophagectomy in our hospital. The clinicopathological presentation, diagnosis, treatment, and prognostic factors of the patients were respectively investigated. The Kaplan–Meier method and the log rank test were used to calculate and compare overall survival (OS). The Cox proportional hazards model was employed to identify independent prognostic factors. There were 18 males and 6 females with a median age of 60 years (range: 40–78 years). The clinical symptoms, macroscopic type, as well as the radiological and endoscopic features of esophageal ASC were similar to those of esophageal squamous cell carcinoma. Sixteen (88.9%) of the 18 cases who underwent preoperative esophagoscopic biopsy were misdiagnosed as adenocarcinoma or squamous cell carcinoma. The overall median follow‐up period was 36 months, and the median survival time was 32 months. The 1, 3, 5‐year OS rates were 75.0%, 48.5%, and 19.4%, respectively. Univariate analysis showed that gender (P = 0.047), lymph node metastasis (P = 0.007), and TNM stage (P = 0.037) were important factors associated with OS of the 22 patients who underwent radical resection. Multivariate analysis showed that the pathological N stage was the only independent prognostic factor (P = 0.031, hazard ratio [HR], 5.369, 95% confidence interval [CI], 1.167–24.700). These results suggest that esophageal ASC is an uncommon disease prone to be misdiagnosed by endoscopic biopsy. Surgical resection is the primary treatment, but the prognosis of ASC is usually poorer than conventional squamous cell carcinoma. Lymph node metastasis is an independent prognostic factor after radical resection.     

Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study

Background Percutaneous microwave ablation and radiofrequency ablation are two commonly used modalities for the treatment of hepatocellular carcinoma; however, comparisons of them have not been documented adequately. Methods Of 102 patients with biopsy-proved hepatocellular carcinoma, 49 (98 nodules) were treated percutaneously with microwave ablation and 53 (72 nodules) with radiofrequency ablation. The local tumor control, complications related to treatment, and long-term results of the two modalities were compared retrospectively. Results The complete ablation rates were 94.9% (93/98) using microwave ablation vs 93.1% (67/72) using radiofrequency ablation (P = 0.75), and no significant differences were found either in the ablation of tumors of 3.0 cm or less (P = 1.00) or in those of more than 3.0 cm (P = 1.00) between the two modalities. The local recurrence rates were 11.8% (11/93) using microwave ablation vs 20.9% (14/67) using radiofrequency ablation (P = 0.12), and there were no significant differences between the two modalities either in tumors of 3.0 cm or less (P = 0.36) or in those of more than 3.0 cm (P = 0.82). The rates of major complications associated with microwave ablation and radiofrequency ablation were 8.2% (4/49) vs 5.7% (3/53; P = 0.71). The disease-free survival rates in the microwave ablation group were 45.9%, 26.9%, 26.9%, and 13.4% at 1, 2, 3, and 4 years, respectively, and those in the radiofrequency ablation group were 37.2%, 20.7%, and 15.5% at 1, 2 and 3 years, respectively (P = 0.53). The 1-, 2-, 3-, and 4-year cumulative survival rates for patients who underwent microwave ablation were 81.6%, 61.2%, 50.5%, and 36.8%, respectively, and for patients who underwent radiofrequency ablation the rates were 71.7%, 47.2%, 37.6%, and 24.2%, respectively (P = 0.12). Conclusions Percutaneous microwave ablation and radiofrequency ablation are both effective methods in treating hepatocellular carcinomas. The local tumor control, complications related to treatment, and long-term survivals were equivalent for the two modalities.     

Small angiomyolipoma of the liver diagnosed by fine-needle aspiration biopsy under ultrasound guidance

The first reported case of small hepatic angiomyolipoma to be diagnosed by fine-needle aspiration biopsy (FNAB) is described. A 53 year old man presented with a tumour in segment VI of the liver measuring 0.9 × 0.8 cm. The tumour was hyperechoic on ultrasound examination, showed relatively low density (+ 33 Hounsfield units) on computed tomography (CT), and was hypervascular on angiography. Computed tomography during arterial portography demonstrated a perfusion defect. Magnetic resonance imaging (MRI) revealed high intensity by both T1- and T2-weighted imaging. Diagnosis could not be obtained by these imaging modalities, but it was established successfully by FNAB under ultrasound guidance. Histologically, the tumour was an angiomyolipoma made up of three components: blood vessels, smooth muscle and fatty tissue. Surgery is unnecessary for this benign condition, and the patient has been followed up. Ten months later, the patient is currently doing well without growth of the hepatic angiomyolipoma.