肝脏局灶性结节性增生的超声表现

目的 总结肝脏局灶性结节性增生(FNH)的超声表现,探讨超声检查的诊断价值.方法 14例肝脏局灶性结节性增生患者均经病理证实,共16个病灶接受了二维灰阶超声及彩色多普勒超声检查.结果 14例16个病灶的二维灰阶超声检出率为100%.二维灰阶超声显示10个病灶位于肝右叶,5个病灶位于肝左叶,1例病灶位于肝左叶与右叶之间.6个病灶表现为等或稍低回声,8个病灶为低回声,2个病灶为高回声.12个病灶探及较丰富彩色多普勒动脉频谱,4个病灶血流呈现轮辐状;峰值流速为26.1～121.6cm/s,均值为58.5 cm/s;阻力指数(RI)为0.36～0.81,均值为0.51.所有患者的AFP均为阴性.结论 肝脏局灶性结节性增生具有较为特殊的超声表现,结合其AFP为阴性,可提高超声检查的诊断率.     

Magnetic resonance features of focal nodular hyperplasia of the liver

The magnetic resonance imaging (MRI) features of 11 biopsy-proven lesions of focal nodular hyperplasia (FNH) of the liver were reviewed retrospectively. Only three lesions showed atypical features. It is believed MRI can reliably differentiate FNH from other liver tumours when strict criteria are fulfilled.     

Ewing's sarcoma metastatic to focal nodular hyperplasia of liver

A case is presented of a young woman discovered at thoracotomy to have Ewing's sarcoma of the left lower ribs with soft tissue extension to the diaphragm and thoracic wall. Laparotomy at the same operation showed a nodule of focal nodular hyperplasia of the liver with a focus of metastasis from the sarcoma within the area of hyperplasia. This is the first report of metastasis of any tumor to a hepatic lesion of this sort. Possible reasons for metastasis to this type of lesion are discussed.     

Focal nodular hyperplasia of the liver with alcoholic hyalin bodies and cytologic atypia.

Focal nodular hyperplasia is an uncommon hepatic lesion in which the component hepatocytes are usually histologically normal. A case of focal nodular hyperplasia with cytologically atypical hepatocytes is presented. Light and electron microscopic evidence is given for the presence of alcoholic hyalin in these cells. A review of cytologic changes reported in focal nodular hyperplasia by others is included. To our knowledge, the presence of alcoholic hyalin in focal nodular hyperplasia has not previously been reported.     

肝脏局灶性结节性增生48例临床分析

目的 探讨肝脏局灶性结节性增生(FNH)准确诊断和合理治疗的方法。方法 对48例FNH患者的临床资料进行总结,分析其临床病理特征。全部患者均行手术切除并经病理证实。结果 大多数FNH患者无明显症状,血清学检查正常。25例患者的CT和MRI检查均有一定的特征性表现。29例FNH病灶切面具有典型的星状疤痕。全组患者手术并发症发生率2．1％,无手术死亡。随访4年未见肿瘤复发。结论 FNH发病与服用避孕药关系不大;CT和MRI对FNH具有较高的诊断价值;手术切除是FNH首选的治疗方法,但对诊断明确而瘤体较小、无明显症状的FNH患者,可密切随访及定期观察。     

肝局灶性结节增生患者的典型与不典型螺旋CT征象分析

背景与目的：肝局灶性结节增生（focal nodular hyperplasia,FNH）是一种少见的肝脏肿瘤样病变。本研究旨在探讨该病典型与不典型的螺旋CT征象．从而提高对该病的影像学诊断水平。方法：对中山大学肿瘤防治中心病理证实或临床确诊的32例FNH患者的37个病灶的螺旋CT征象,包括病灶数目、大小、边缘情况、密度、强化形式、中央瘢痕、假包膜等进行比较分析。结果：在37个病灶中,有14个病灶最大径≤3cm,有23个病灶最大径〉3cm;有20个病灶位于肝包膜下;有7个病灶周边存在假包膜,这7个病灶最大径〉3cm;有22个病灶存在中央瘢痕,其中有20个病灶最大径〉3cm。所有病灶在动脉期均呈高密度．其中31个病灶肿瘤实质均匀强化,17个病灶周边可见异常增粗的血管影。结论：FNH典型的cT征象是动脉期明显均匀强化、存在中央瘢痕并延迟强化：FNH不典型的CT征象是动脉期不均匀强化、无中央瘢痕、存在假包膜。征象的多样性与病灶的病理类型和病灶的最大径相关。     

The clinical course in pediatric solid tumor patients with focal nodular hyperplasia of the liver

Background

Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that may be related to the vascular and hepatic damage induced by completion of tumor therapy and a reaction to localized vascular abnormality. The aim of this study was to analyze the clinical course in pediatric solid tumor patients with FNH.

Methods

We analyzed thirty-two patients with pediatric solid tumors who received multiagent chemotherapy (15 advanced neuroblastomas, 7 hepatoblastomas, 5 rhabdomyosarcomas, 2 nephroblastomas, 1 rhabdoid tumor of the kidney, 1 clear cell sarcoma of the kidney and 1 pancreatoblastoma). All of them had been previously treated at our hospital, and have been alive for over 3 years without recurrence.

Results

FNH lesions were discovered in three (9.4%) of 32 patients, and were neuroblastoma (NB) stage 4. All 3 patients received induction chemotherapy and high-dose alkylating agents, and developed grade 3 (National Cancer Institute Common Toxicity Criteria; NCI-CTC) liver dysfunction during completion of tumor therapy without veno-occlusive disease. Two of the 3 patients received the same induction chemotherapy and high doses of alkylating agents with total body irradiation for cytoreductive agents prior to peripheral blood cell transplantation. FNH lesions in both female patients who received estrogen replacement therapy after completion of tumor therapy have expanded and are increasing.

Conclusion

FNH appears to be a late complication of iatrogenic disease in NB stage 4 patients. The therapeutic agents for NB stage 4 and estrogen replacement therapy should be considered as risk factors for the development of FNH.     

A serotonin and beta HCG-producing islet cell carcinoma associated with focal nodular hyperplasia of the liver

A 48-year-old woman is described with a pancreatic islet cell carcinoma that had no clinical evidence of hormone production. This neoplasm was removed by radical distal pancreatectomy. Immunohistochemical and extraction studies performed on the tumor tissue revealed that it was producing serotonin and beta HCG. Circulating levels of these hormones were elevated in preoperative serum samples that had been frozen. Beta HCG, a known tumor marker, has remained normal following operation, and this mirrors her clinical course since she has no evidence of disease 1.5 yr after operation. This patient also had focal nodular hyperplasia of the liver. It is possible that the trophoblastic hormone, beta HCG, which was being produced in excess by the islet tumor, may have directly or indirectly caused or facilitated the development of focal nodular hyperplasia.     

Cytological diagnosis of nodular hyperplasia and cancer of the prostate

The results of histological and cytologic examination of the material obtained from 289 transrectal punction biopsies of the prostate carried out in 278 patients were compared. Smears were prepared from bioptates and stained haematoxylineosin after the method of Papenheim, Papanicolaou modified by A. V. Rudenko and L. K. Koonitsa. They were also treated with acridin orange (1:10,000). The histological examination established cancer in 66, nodose hyperplasia--97, chronic prostatitis--38, tuberculosis--4, fibrosis of prostatic stroma--9 and unaltered tissue in 48 cases. Cancer was suspected in 8 cases, while prostatic tissue was not identified in preparations in 8 cases. The cytological study detected cancer in 73 and chronic prostatitis in 42 cases. Cancer was suspected in 8 cases. No tumor or epithelial elements were identified in 148 and 7 cases, respectively. The cytological diagnosis was valid in 81% and cancer was erroneously diagnosed in 18 cases. Malignancy was not detected in 11 cancer patients. The cytological analysis failed to identify any difference between nodose hyperplasia and unaltered tissue of the prostate. It proved to be able to verify clear- and dark-celled adenocarcinoma as well as small cell and polymorphocellular carcinoma. However, it also failed to identify cribriform carcinoma and anaplastic adenocarcinoma.     

常规超声及超声造影对结节性肝癌及肝局灶性结节性增生的鉴别诊断价值

目的 分析结节性肝癌及肝局灶性结节性增生(FNH)的超声特征及超声造影特征.方法 回顾性分析40例结节性肝癌患者(结节性肝癌组)及40例FNH患者(FNH组)的临床资料,所有患者均接受常规超声及超声造影检查,观察两组患者的超声特征及不同时相的超声造影特征.结果 结节性肝癌组患者门静脉癌栓(22.5％vs 0)、肝硬化(60.0％vs 15.0％)及淋巴结肿大(20.0％vs 2.5％)的发生率高于FNH组,中心瘢痕(15.0％vs 62.5％)的发生率低于FNH组,病灶位于肝包膜下的比例(22.5％vs 52.5％)低于FNH组,差异均有统计学意义(P﹤0.05).两组患者的超声动脉相均以高增强为主,动脉相增强模式比较,差异无统计学意义(P﹥0.05);对于门脉相及延迟相,结节性肝癌组患者均以低增强为主,FNH组患者均以等低增强为主,两组患者的门脉相及延迟相增强模式比较,差异均有统计学意义(Z=2.754、3.556,P﹤0.01).结节性肝癌组患者的上升时间(RT)[(21.9±8.7)s vs(27.8±9.2)s]、达峰时间(TTP)[(29.6±9.3)s vs(36.1±11.8)s]及平均通过时间(mTT)[(102.1±37.7)s vs(136.2±42.1)s]均明显短于FNH组,灌注指数(PI)[(122.8±31.6)vs(85.9±22.2)]明显高于FNH组,差异均有统计学意义(P﹤0.01).结论 结节性肝癌和FNH具有较为典型的超声特征及超声造影特征,可对两者进行较准确的鉴别诊断.     

Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases

Introduction

Sinusoidal obstructive syndrome (SOS) is well associated with the use oxaliplatin-based chemotherapy, and represents a spectrum of hepatotoxicity, with nodular regenerative hyperplasia (NRH) representing the most significant degree of injury. The aim of this study was to determine the prevalence of NRH in patients undergoing resection of colorectal liver metastases (CRLM) and to determine its impact on outcome.

Methods

From January 2000 to December 2010, some 978 first primary liver resections were performed for CRLM. A prospectively maintained database was analysed to identify all patients with evidence of NRH in the non-tumour portion of their histopathology specimens. Clinical data of these patients was reviewed and outcomes assessed.

Results

Five patients exhibited NRH (four males, one female) with a median age of 69 years (range: 35–74). Three patients presented with synchronous hepatic metastases, and two with metachronous lesions. All received at least 6 cycles of oxaliplatin as either adjuvant or neo-adjuvant chemotherapy. Only one patient developed a post-operative complication namely transient hepatic failure that required a 4-day stay in the intensive care unit. The median hospital stay was 6 days (range: 6–14 days). There were no 90-day mortalities. One patient is alive and disease free at 55 months, the remaining 4 died of recurrent disease between 37 and 70 months following diagnosis of their primary tumours.

Conclusions

NRH is not an uncommon finding amongst patients with SOS with all patients having received oxaliplatin-based chemotherapy. Data on outcome would suggest no increased morbidity and mortality associated with the presence of NRH.     

Breast cancer risk of lobular-based hyperplasia after biopsy: "ductal" pattern lesions

Three thousand three hundred three women were followed an average of 17 years following benign breast biopsy. These women comprise 84.4% of those originally targeted for follow-up. Risk of invasive breast cancer development was analyzed in relation to the hyperplasia classification scheme of Wellings et al (JNCI 1975; 55:231-73) that is based on terminal ductal-lobular units (ALA). Cancer risk was also assessed with respect to family history of breast cancer in first-degree relatives (FHBC), as well as atypical features of hyperplasia recognized by resemblance to carcinoma in situ of ductal type (ADH). There was a trend of increasing cancer risk with increasing degree of ALA lesion, reaching 1.9 with ALA-IV lesions having both qualitative and quantitative features of advanced atypical hyperplasia. When ADH lesions are removed from the analysis, any predictive power of ALA lesions is lost. ADH recognizes histologic lesions with a four- to fivefold increased risk of breast cancer. FHBC interacts with any hyperplastic lesion so as to approximately double the cancer risk.     

肝局灶性结节性增生的鉴别诊断

目的 分析肝局灶性结节性增生(FNH)的病理形态学特点、病理诊断和鉴别诊断.方法 回顾7例FNH患者临床病理资料,采用HE染色并结合免疫组织化学观察其形态特点.结果 男性4例,女性3例,年龄19～52岁,中位年龄34岁.组织学上有特征性中央纤维星状瘢痕、异常结节状结构、畸形血管和毛细胆管增生.7例FNH中5例为经典型,1例为毛细血管扩张型,1例为混合型.结论 FNH为肝脏良性增生性病变,组织学上应与肝细胞腺瘤、肝腺瘤样结节增生、分化好的肝细胞肝癌和肝纤维板层癌进行鉴别.     

Histone H4 histidine kinase displays the expression pattern of a liver oncodevelopmental marker

Protein phosphorylation is a vital process in the regulation of mammalian cell division and the protein kinases that catalyze the phosphorylation of proteins on serine, threonine and tyrosine residues have been well characterized. In contrast, little is known about the kinases involved in protein histidine phosphorylation, which have been described in various mammalian cells that are highly proliferative. Histone H4 histidine kinase (HHK) activity is highly active in regenerating rat liver. Using a novel and specific assay, we demonstrate that it is active in human fetal liver, essentially absent in adult liver and highly expressed in liver tumours. 'Normal' liver surrounding the HCC contains low to undetectable levels of HHK. In a rodent model of chronic liver injury that leads to HCC, its activity is induced. Two lines of evidence suggest that liver progenitor (oval) cells, which populate the liver at early stages following induction of liver damage are responsible for the increased activity. Purified oval cells, as well as cell lines established from primary cultures of oval cells express high levels of HHK. We propose that the pattern of expression of histone H4 histidine kinase activity justifies its classification as an oncodevelopmental marker and suggest it may be useful as a diagnostic marker for hepatocellular carcinoma as well for identifying preneoplastic lesions.     

肝脏局灶性结节增生的螺旋CT平扫及三期增强扫描

目的 分析肝脏局灶性结节增生（FNH）的螺旋CT平扫及三期增强扫描表现,以提高对FNH的诊断准确率。方法对21例21个经手术病理证实的FNH进行螺旋CT平扫及增强的动脉期、门脉期、延迟期扫描。其中2例行肝动脉血管造影。结果 21个FNH,平扫16个为低密度,5个为等密度,其中12个病灶中央有点状、条状、放射状低密度影。动脉期21个FNH除中央疤痕外,均明显均匀强化,9例见明显增粗的供血动脉;门脉期病灶密度下降,但均高于或略高于肝实质;延迟期病灶呈等密度或略低于肝实质,3例见包膜强化。血管造影可见粗大的供血动脉及引流静脉。结论 FNH在螺旋CT平扫及三期增强扫描中的特征性表现,对FNH的确诊及治疗方案的选择有重要价值。     

肝局灶性结节增生的不典型螺旋CT征象分析

目的探讨肝局灶性结节增生(FNH)不典型的螺旋CT征象。方法对病理证实或临床确诊的32例FNH患者37个病灶的螺旋CT征象进行回顾性分析。结果 37个病灶中,有 14个病灶直径≤3 cm,23个病灶直径>3 cm;7个病灶周边存在假包膜;22个病灶存在中央瘢痕, 其中有20个病灶直径>3 cm;所有病灶在动脉期均呈高密度,其中31个病灶肿瘤实质均匀强化。结论多发病灶、存在假包膜、无中央瘢痕、动脉期不均匀强化是FNH不典型的CT征象。征象的多样性与病灶的病理类型和病灶的直径相关。     

肝局灶性结节增生的不典型螺旋CT征象分析

目的探讨肝局灶性结节增生（FNH）不典型的螺旋CT征象。方法对病理证实或临床确诊的32例FNH患者37个病灶的螺旋CT征象进行回顾性分析。结果37个病灶中,有14个病灶直径≤3cm,23个病灶直径〉3cm;7个病灶周边存在假包膜;22个病灶存在中央瘢痕。其中有20个病灶直径〉3cm;所有病灶在动脉期均呈高密度,其中31个病灶肿瘤实质均匀强化。结论多发病灶、存在假包膜、无中央瘢痕、动脉期不均匀强化是FNH不典型的CT征象。征象的多样性与病灶的病理类型和病灶的直径相关。     

A case of nodular pseudoangiomatous stromal hyperplasia (pash)

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a common microscopic lesion that is found at breast biopsy, and presents with proliferation of the stromal cells and slit-like pseudovascular spaces with endothelial-like spindle cells. In contrast, nodular PASH is relatively rare. We report here a case of nodular PASH with multiple palpable masses. A 49-year-old woman who had experienced gradual enlargement of her breasts for 13 years noticed an elastic but firm palpable mass in her breast. We were able to detect 7 masses in her right breast and 2 in the left. Ultrasonography and mammography demonstrated nonspecific findings, and FNA and CNB did not establish a diagnosis. An excisional biopsy was performed, and the pathological findings revealed nodular PASH. Eighteen months after the excisional biopsy, the size of the nodules and the whole breast had decreased remarkably. While the possibility of a change in the hormonal background or the influence of drugs was considered, we were not able to reach a single specific conclusion regarding the pathogenesis.