共查询到19条相似文献,搜索用时 93 毫秒
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李占峰 《中华腹部疾病杂志》2004,4(9):F003-F004
肝内胆管细胞癌占原发性肝癌的3.25%-8.2%,临床少见且术前诊断困难,CT检查是肝内胆管细胞癌定位和定性的重要影像学手段。现将肝内胆管细胞癌的CT表现综述如下。 相似文献
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目的探讨提高周围型胆管细胞癌(PCC)与肝细胞癌(HCC)诊断率的最佳方法。方法对经手术病理证实的15例PCC及25例HCC患者的临床及MR特点进行分析。结果PCC临床多见CEA(+)及合并胆道病变;HCC则多见AFP(+)、乙肝病史及肝硬化。MR检查PCC动脉期多无明显强化,延迟期明显强化,常伴有瘤内胆管征、肝内胆管扩张及淋巴结转移;HCC动脉期多明显强化,延迟期基本无明显强化,主要表现为假包膜征象,门静脉系统常受侵袭。结论PCC与HCC的临床特点及MR动态强化方式不同;MR动态增强扫描对二者的诊断及鉴别诊断有较大价值。 相似文献
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笔者诊治1例64岁男性肝内胆管细胞癌(ICC)患者。本患者主要表现为腹痛、高热和肝脏多发占位,曾被诊断为急性胆囊炎、肝脏转移瘤,抗感染治疗后发热仍难以控制,查糖类抗原199(CA199)3 222U/ml,结合肝穿刺活检明确诊断为ICC,肿瘤坏死伴感染,急性胆囊炎,给予姑息、对症治疗,2个月后死亡。根据文献报道和笔者的临床经验,ICC早期发现难,恶性程度高,可伴发坏死感染,根治性切除机会少,预后差。老年消化科医师应熟悉ICC特点,重视健康查体工作,以利于本病的早期诊断和治疗。 相似文献
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患者 :吴某 ,女 ,56岁 ;因肝区及中上腹疼痛 3个月为主诉于 1999年 6月 9日入院。既往胆囊结石病史 4 0余年。查 ;中上腹及右上腹压痛阳性 ,无反跳痛 ,莫菲氏征阳性 ,肝区叩击痛阳性 ,无移动性浊音 ,血沉 2 2mm/h ,肝炎标记物均阴性 ,AFP <2 5ng/mL。肝功 :总蛋白 74G/L、白蛋白 4 4G/L、GGT :2 2 2IU /L ,ALT、AST均正常。腹部B超 :肝右叶可探及 7.8cm× 7.4cm无回声暗区 ,胆囊内可探及 1.6cm× 0 .7cm大小结石影。腹部CT :肝大 ,各叶比例失调 ,肝右叶可见 6.6cm× 7.0cm大小低密度灶 ,边界光整 … 相似文献
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Meng-Meng Qu Yuan-Hui Zhu Yi-Xiang Li Zhi-Fan Li Jin-Kui Li Yong-Sheng Xu Manishkumar Shrestha Jun-Qiang Lei 《Medicine》2021,100(46)
Rationale:Presence of synchronous double hepatocelluar carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (sdpHCC-ICC) located separately within a single liver is extremely rare. The purpose of this study is to investigate the clinical, imaging, pathological characteristics, and prognosis of patients with sdpHCC-ICC, in order to enhance our understanding of the disease and improve diagnostic and therapeutic effect.Patient concerns:A 49-year-old, female with the diagnosis of hepatitis B virus with obvious liver cirrhosis, was admitted to our hospital. On admission, the levels of α-fetoprotein and carbohydrate antigen 19-9 were found to be elevated. Abdominal ultrasonography and enhanced computed tomography revealed 2 solid masses located in segments (S) 4 and 6 of the liver, with malignant behaviors.Diagnoses:In the light of above investigations, preoperative diagnosis of multiple primary hepatocellular carcinomas was made.Intervention:Hepatic resection of both segments was done. The resected specimens revealed the presence of well-defined tumors in segments 4 and 6 measuring 5.0 cm and 2.5 cm respectively.Outcomes:Histopathological examination confirmed the tumor of the 4th segment to be moderately and poorly differentiated ICC, and the tumor of the 6th segment to be poorly differentiated HCC. Immunohistochemically, the ICC in S4 was positive for CK19 and negative for Heppar-1, whereas the HCC in S6 was positive for Heppar-1 and negative for CK19. Unfortunately, metastasis to multiple organs and lymph nodes were observed 3 months later. The patient died of liver failure 16 months after surgery.Lessons:The clinical characteristics of sdpHCC-ICC are usually atypical and nonspecific making its preoperative diagnosis quite difficult. Hepatitis B virus and hepatitis C virus infection were both the independent risk factor for the development of sdpHCC-ICC. In patients with chronic liver disease, careful observation with imaging is of utmost necessity. Tumor markers may also play a valuable role in the diagnosis. The definite diagnosis depends on pathological examination. Hepatic resection is considered the most effective mode of treatment. The prognosis of synchronous occurrence of double hepatic cancers is worse than either HCC or ICC, and the origin of the disease needs further study. 相似文献
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Tsan-Chieh Liao Chien-An Liu Nai-Chi Chiu Yi-Chen Yeh Yi-You Chiou 《World journal of gastroenterology : WJG》2015,21(13):4089-4095
Primary lymphoepithelioma-like carcinoma in the liver is extremely rare. A few cases of lymphoepithelioma-like cholangiocarcinoma have been reported, but few radiologic features were described. We reviewed 23 cases of lymphoepithelioma-like cholangiocarcinoma reported between 1996 and 2014 and describe a rare case of a 35-year-old woman in our hospital who was diagnosed with lymphoepithelioma-like cholangiocarcinoma of the liver and was a hepatitis B carrier. The tumor(1.6 cm) in our patient appeared to be hypoechoic in sonographic images and hypodense in computed tomography(CT) images. In addition, it was homogeneous hypointense in T1-weighted magnetic resonance(MR) images(MRI) and hyperintense in T2-weighted MRI. Dynamic gadolinium-enhanced MRI showed typical image pattern of hepatocellular carcinoma(HCC). The patient underwent a laparoscopic left hepatic lobectomy, and the resected tumor consisted of well-differentiated glandular cells with extensive lymphocytic infiltration that were immunoreactive to CK(AE1/AE3), CD3, and CD20. In addition, the tumor was positive for Epstein-Barr virus-encoded RNA in situ hybridization. Finally, lymphoepithelioma-like cholangiocarcinoma was diagnosed. In previous studies, the incidence is highest among middle-aged people. Most tumors appeared to be hypodense with either hypovascular or hypervascular patterns in CT images. This case report is the first study to address sonography, CT, and MRI observations and delineate pathologic correlations. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either the typical cholangiocarcinoma pattern or a mimic of HCC, should be considered in the differential lists for HCC. 相似文献
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Huai-Quan Zuo Lu-Nan Yan Yong Zeng Jia-Ying Yang Hong-Zhi Luo Jiang-Wen Liu Li-Xin Zhou Department of General Surgery West China Hospital Sichuan University Chengdu China 《Hepatobiliary & Pancreatic Diseases International》2007,(2)
BACKGROUND: Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is a rare subtype of primary liver cancer, and clinicopathological features of cHCC-CC have seldom been reported in detail. This study was undertaken to explore the diagnosis and clinicopathological characteristics of cHCC-CC in comparison with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC), respectively. METHODS: The clinical data from 15 patients with cHCC-CC, 132 patients with HCC and 44 patients with CC who had undergone hepatic resection were analyzed retrospectively. Clinicopathological characteristics of cHCC-CC, HCC and CC such as hepatitis B viral infection, serum hepatitis C virus (HCV) antibody, serum alpha-fetoprotein (AFP) level, cirrhosis, vascular invasion, lymph node metastasis, surgical procedure and adjuvant treatment were also analyzed. Follow up was carried out in the patients, and their 1-, 3-, and 5-year survival rates were calculated. RESULTS: Two patients with cHCC-CC were correctly diagnosed by enhanced CT before operation, the other 13 patients were diagnosed by histology and immunohistochemistry after operation. Radical (8/15) and conservative hepatectomy (7/15) for cHCC-CC was similar to that for HCC and CC (P>0.05). Pathologically cHCC-CC showed more significantly vascular invasion and lymph node metastasis than HCC (P<0.05), and a similarity to CC (P>0.05). Hepatitis B viral infection, serum HCV antibody, cirrhosis, and serum AFP level of cHCC-CC patients were similar to those of HCC patients(P>0.05) but different from CC patients (P<0.05). The cumulative 1-, 3-, and 5-year survival rates in patients with cHCC-CC were poorer than in patients with HCC or CC (P<0.05). CONCLUSIONS: Patients with cHCC-CC are seldom diagnosed before operation. The progression of cHCC-CC is more rapid than that of HCC or CC. Survival rate of patients with cHCC-CC after hepatic resection is poorer than that of patients with HCC or CC. 相似文献
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Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo 《Hepatobiliary & pancreatic diseases international : HBPD INT》2017,16(3):264-270
BACKGROUND: Reports of liver transplantation (LT) in pa-tients with mixed hepatocellular carcinoma/cholangiocarci-noma (HCC/CC) and intrahepatic cholangiocarcinoma (ICC) are modest and have been mostly retrospective after patho-logical categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60%5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC.METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who un-derwent LT with explant pathology revealing HCC/CC or ICC. RESULTS: The observed recurrence rate post-LT was 31%(4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four pa-tients would have qualified for exception points based on up-dated HCC Organ Procurement and Transplantation Network imaging guidelines.CONCLUSIONS: Lesions which lack complete imaging char-acteristics of HCC may warrant pre-LT biopsy to fully eluci-date their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incor-porating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation. 相似文献
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Xin-Da Zhou Zhao-You Tang Jia Fan Jian Zhou Zhi-Quan Wu Lun-Xiu Qin Zeng-Chen Ma Hui-Chuan Sun Shuang-Jian Qiu Yao Yu Ning Ren Qing-Hai Ye Lu Wang Sheng-Long Ye 《Journal of cancer research and clinical oncology》2009,135(8):1073-1080
Purpose To clarify clinicopathologic differences between patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma
(HCC), and identify potential factors influencing survival after hepatectomy for ICC.
Methods Comparison of clinicopathologic data was made between patients who underwent hepatectomy for ICC (n = 272) and HCC (n = 5,829) during the same period. Twenty-five clinicopathologic variables were selected for univariate and multivariate analyses
to evaluate their influence on prognosis of ICC.
Results Compared with patients with HCC, ICC patients were more common in females and more elderly, had a lower proportion of asymptomatic
tumors, lower serum alpha-fetoprotein, higher serum carcinoembryonic antigen, carbohydrate antigen 19–9 and alkaline phosphatase
levels; lower incidence of hepatitis history, associated cirrhosis and serum hepatitis B surface antigen; lower proportion
of small tumors, well-encapsulated tumors and tumor emboli in the portal vein; higher proportion of single tumor, perihila
lymph node involvement and poor differentiation; and less frequency of limited resection (all, P < 0.0001). Distant metastasis was less frequent in patients with ICC (P = 0.027). A total of 5-years overall and disease-free survival (in brackets) after resection was 26.4% (13.1%) and 44.5% (33.1%)
(P < 0.0001, P < 0.0001) for patients with ICC and HCC, respectively. Factors influencing survival after resection of ICC can be divided
mainly into two categories: early detection of asymptomatic ICC (P < 0.0001) and curative resection (P = 0.002).
Conclusion ICC Patients have distinct clinicopathologic features as compared with HCC patients. Surgery remains the only effective treatment
for ICC. Early detection of asymptomatic ICC and curative resection were the key to achieve optimal survival. 相似文献