肝内胆管细胞癌的CT表现

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。     

肝内胆管细胞癌的CT特点及病理基础

目的对比研究肝内胆管细胞癌(IHCC)的CT表现与病理的关系。方法分析病理学证实的肝内胆管细胞癌患者22例,比较CT平扫及动态增强扫描方式和病理学特点。结果 IHCC在CT平扫期均为圆形或类圆形或不规则低密度肿块,动态增强扫描动脉期均呈不规则轻度强化,以边缘强化为主,门脉期病灶可无明显强化,或轻度片状、分隔状或延迟性强化。IHCC组织病理学上见肿瘤外周以存活的肿瘤细胞为主,形成早期边缘强化,而肿瘤中央以纤维成分为主,形成延迟强化的基础。结论动态增强动脉期边缘轻度强化,延迟后强化范围增加或不变是IHCC的典型表现,增生的纤维组织是延迟强化的病理基础。增强期分叶状或花瓣状肿瘤形态及肝内胆管扩张是IHCC的特异性表现,有一定的病理学基础。     

肝内胆管细胞癌的动态增强多层螺旋CT表现

目的探讨肝内胆管细胞癌（ICC）的CT影像学特点,以提高临床诊断ICC的准确性。方法以经病理证实的29例ICC患者为研究对象,回顾性研究其临床特征和CT影像学的改变情况。结果共检测到肝内病灶43个,其中69．8％（30／43）位于肝左叶,16．3％（7／43）位于肝右叶,病灶大小平均为5．1cm×3．8cm;在本组病例中,72．1％（31／43）的病灶形态不规则,23．3％（10／43）的病灶呈结节状;83．7％（36／43）的病灶有坏死囊变区,39．5％（17／43）的病灶内胆管扩张,34．9％（15／43）病灶内可见结石。在动脉期,病灶周边呈带状强化,而本身边缘多呈环形强化且72．1％（31／43）病灶内部呈结节状强化;在门静脉期与平衡期,各病灶强化均进一步增强。结论ICC的CT征象具有一定的特征性,了解ICC的CT表现对提高疾病诊断的准确性具有重要价值。     

超声内镜诊断肿块型肝内胆管细胞癌1例

<正>肝内胆管细胞癌(intrahepatic cholangiocarcinoma, ICC)又称肝内胆管癌,是起源于肝内2级胆管及其分支上皮的恶性肿瘤,好发于肝左叶,占胆管细胞癌的20%～25%[1],是发病率居第2的肝脏原发恶性肿瘤,近年发病率呈上升趋势,早期缺乏特异的临床症状、血清学检查和早期筛查的分子标志物,诊断较困难。超声内镜(endoscopic ultrasonography, EUS)以及衍生技术在“早期”及“精准”的道路上上不断改革更新,已有国内外文献报道其在诊断及鉴别诊断肝脏疾病上有明显效果。在此,     

肝内胆管细胞癌外科治疗进展

手术切除是肝内胆管细胞癌首选的治疗方法,也是唯一可能的治愈手段。R0切除是影响肝内胆管细胞癌手术预后的重要因素,在保证R0切除和手术安全性的基础上,切缘距离应>10 mm。淋巴结是否转移是肝内胆管细胞癌手术最重要的预后因素之一,淋巴结清扫能改善患者的预后,术后辅以系统治疗可以延长患者的生存期。对于起始不可切除的肝内胆管细胞癌患者,辅助化疗是一个可能获得根治性手术切除机会的有效措施。     

周围型肝内胆管细胞癌的影像学诊断

周围型肝内胆管细胞癌(peripheral intrahepatic cholangiocarcinoma,PICC)是指发生在包括Ⅱ级胆管在内的末梢侧肝内小胆管上皮的细胞癌,又叫末梢型/边缘型肝内胆管癌.     

肝内胆管细胞癌的危险因素分析

目的探讨肝内胆管细胞癌(intrahepatic cholangio carcinoma,ICC)的危险因素。方法将北京大学深圳医院2012年9月~2014年9月收治的ICC患者79例作为研究的试验组,并选择同期158例健康体检者作为对照组。计数资料采用χ2检验,计量资料采用t检验,对相关危险因素先用单因素Logistic回归分析,并对可疑危险因素采用多因素Logistic回归法进行分析。结果经单因素分析,ICC可能的危险因素有肝内胆管结石、酒精性肝硬化、乙型肝炎相关性肝硬化、其他原因肝硬化、胆总管结石,血清HBsAg阳性以及肝血吸虫病(P0.05)。多因素分析,ICC相关的危险因素是肝内胆管结石、酒精性肝硬化、乙型肝炎相关性肝硬化、其他原因肝硬化、肝血吸虫病、血清HBsAg阳性(P0.05)。结论 ICC的危险因素有多种,肝内胆管结石是其中的一个危险因素。     

腹痛、发热及肝脏多发占位为主要表现的肝内胆管细胞癌1例

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。     

常规超声和超声造影检查诊断肝内胆管细胞癌

目的 探讨肝内胆管细胞癌(ICC)常规超声和超声造影(CEUS)表现.方法 本组纳入52例ICC患者,常规行超声和CEUS检查,组织病理学诊断.结果 灰阶超声表现为均匀低回声者23例(44.2％,不均匀低回声者22例(42.3％),稍高和高回声者7例(13.5％);彩色多普勒血流(CDFI)表现为0级11例(21.2％...     

MRI及MSCT用于肝内胆管细胞癌临床诊断的效能分析

目的 分析磁共振成像(MRI)和多层螺旋计算机断层扫描(MSCT)对肝内胆管细胞癌(ICC)的诊断价值。方法 2017年3月至2022年3月徐州医科大学附属医院收治的原发性肝癌患者70例,患者均接受MRI和MSCT检查,以手术后组织病理学检查和穿刺活检为金标准,MRI、MSCT联合诊断时任意一种方法诊断为ICC即判定为ICC,评估MRI和MSCT单独及联合诊断ICC的效能。结果 病理诊断结果显示70例原发性肝癌患者中23例为ICC、47例为肝细胞癌(HCC)。MRI诊断结果显示,70例原发性肝癌中20例为ICC、50例为HCC。MRI诊断ICC的敏感度为69.6%、特异度为91.5%、准确率为84.3%、Kappa值为0.632。MSCT诊断结果显示,70例原发性肝癌中22例为ICC、48例为HCC。MSCT诊断ICC的敏感度为65.2%、特异度为85.1%、准确率为78.6%、Kappa值为0.509。MRI联合MSCT诊断结果显示,70例原发性肝癌中21例为ICC、49例为HCC。MRI联合MSCT诊断ICC的敏感度为82.6%、特异度为95.7%、准确率为91.4%、Kappa值...     

多层螺旋CT扫描对颅咽管瘤的诊断与鉴别诊断价值

目的分析多层螺旋CT扫描对颅咽管瘤的诊断与鉴别诊断价值。方法选择2008—2013年我院收治的颅咽管瘤患者12例,均进行多层螺旋CT扫描,重点观察肿瘤位置、形态、密度、大小及与周围组织的关系。结果多层螺旋CT扫描显示,颅咽管瘤位于鞍上8例,鞍内2例,混合型2例;囊性7例,囊实性3例,实性2例;圆形3例,卵圆形4例,不规则形5例;肿瘤密度为12~56 HU,平均(32.0±1.2)HU;肿瘤直径为1.5~6.9 cm,均有占位效应。结论多层螺旋CT扫描能清晰显示颅咽管瘤的位置、形态、密度、大小及与周围组织的关系,对颅咽管瘤的诊断与鉴别诊断有一定价值。     

Neoadjuvant and Adjuvant Therapy in Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer and causes major economic and health burdens throughout the world. Although the incidence of ICC is relatively low, an upward trend has been seen over the past few decades. Owing to the lack of specific manifestations and tools for early diagnosis, most ICC patients have relatively advanced disease at diagnosis. Thus, neoadjuvant therapy is necessary to evaluate tumor biology and downstage these patients so that appropriate candidates can be selected for radical liver resection. However, even after radical resection, the recurrence rate is relatively high and is a main cause leading to death after surgery, which makes adjuvant therapy necessary. Because of its low incidence, studies in both neoadjuvant and adjuvant settings of ICC are lagging compared with other types of malignancy. While standard neoadjuvant and adjuvant regimens are not available in the current guidelines due to a lack of high-level evidence, some progress has been achieved in recent years. In this review, the available literature on advances in neoadjuvant and adjuvant strategies in ICC are evaluated, and possible challenges and opportunities for clinical and translational investigations in the near future are discussed.     

Pulmonary Arterial Hypertension Induced by Immune Checkpoint Inhibitor Combined Therapy in a Patient with Intrahepatic Cholangiocarcinoma: A Case Report

Immune Checkpoint Inhibitors (ICIs) have dramatically revolutionized the therapeutic approaches by which we treat a series of cancers accompanied by immune-related adverse events (irAEs). Herein, we reported an intrahepatic cholangiocarcinoma male patient with a history of ankylosing spondylitis developing pulmonary arterial hypertension (PAH) under ICI combined therapy with pembrolizumab and lenvatinib. The indirect measurement of cardiac ultrasound showed a pulmonary artery pressure (PAP) of 72mmHg after 21 three-week cycles of ICI combined therapy. The patient partially responded to the treatment of glucocorticoid and mycophenolate mofetil. The PAP decreased to 55mmHg 3 months after the ICI combined therapy was discontinued, but increased to 90mmHg after the ICI combined therapy was rechallenged. We treated him with adalimumab -an antitumor necrosis factor-alpha (ani-TNF-α) antibody- combined with glucocorticoid and immunosuppressants under lenvatinib monotherapy. The patient responded again with PAP decreasing to 67mmHg after 2 two-week cycles of adalimumab. Accordingly, we diagnosed him to have irAE-related PAH. Our findings supported the use of glucocorticoid disease-modifying antirheumatic drugs (DMARDs) as a treatment option in refractory PAH.     

螺旋CT 和MRI 对肝内周围型胆管癌诊断价值分析

目的探讨螺旋计算机断层成像（CT）和磁共振成像（MRI）技术对肝内周围型胆管癌（IHPCC）的诊断价值。方法经病理学检查证实的80例IHPCC患者,均行螺旋CT和MRI平扫、增强和延迟扫描检查,比较影像学检查诊断的正确率。结果影像学上病灶为1.3 cm×2.0 cm~7.3 cm×9.0 cm （平均4.6 cm×6.4 cm）;位于肝左叶58例,肝右叶22例;呈肿块型46例（57.50%）、浸润狭窄型17例（21.25%）、腔内生长型10例（12.50%）、肿块不明确7例（8.75%）;CT平扫病灶呈略低密度,增强扫描时病灶分别呈轻中度的边缘强化50例、中央轻度条状或片状强化12例和无强化18例,延迟扫描时呈不均匀性片状或分隔状强化47例、均匀强化5例和无强化28例;MRI平扫较CT显示病灶更为清晰,延迟后73例病灶逐渐强化;MRI诊断正确率为91.3%,CT诊断正确率为80.0%,两者比较差异无统计学意义（P>0.05）。结论增强延迟扫描可提高螺旋CT和MRI诊断IHPCC的准确性,诊断IHPCC时可优先考虑行MRI检查。     

Genetic,Clinicopathological, and Radiological Features of Intrahepatic Cholangiocarcinoma with Ductal Plate Malformation Pattern

Background/AimsIntrahepatic cholangiocarcinoma (iCCA) with a ductal plate malformation (DPM) pattern is a recently recognized rare variant. The genomic profile of iCCA with DPM pattern needs to be elucidated.MethodsCases of iCCA with DPM pattern were retrospectively reviewed based on the medical records, pathology slides, and magnetic resonance imaging (MRI) reports collected between 2010 to 2019 at a single center. Massive parallel sequencing was performed for >500 cancer-related genes.ResultsFrom a total of 175 iCCAs, five (2.9%) cases of iCCA with DPM pattern were identified. All cases were of the small duct type, and background liver revealed chronic B viral or alcoholic hepatitis. Three iCCAs with DPM pattern harbored MRI features favoring the diagnosis of hepatocellular carcinoma, whereas nonspecific imaging features were observed in two cases. All patients were alive without recurrence during an average follow-up period of 57 months. Sequencing data revealed 64 mutated genes in the five cases, among which FGFR2 and PTPRT were most frequently mutated (three cases each) including an FGFR2-TNC fusion in one case. Mutations in ARID1A and CDKN2A were found in two cases, and mutations in TP53, BAP1, ATM, NF1, and STK11 were observed in one case each. No IDH1, KRAS, or PBRM1 mutations were found.ConclusionsiCCAs with DPM pattern have different clinico-radio-pathologic and genetic characteristics compared to conventional iCCAs. Moreover, FGFR2 and ARID1A variants were identified. Altogether, these findings further suggest that iCCA with DPM pattern represents a specific subtype of small duct type iCCA.     

Diagnostic Value of Arginase-1 and Glypican-3 in Differential Diagnosis of Hepatocellular Carcinoma,Cholangiocarcinoma and Metastatic Carcinoma of Liver

Background:

Hepatocellular carcinoma is the most common primary liver cancer. Pathologic distinction between Hepatocellular Carcinoma (HCC) and adenocarcinoma (Cholangiocarcinoma (CC) and Metastatic Adenocarcinoma (MA)) can be challenging and sometimes requires immunohistochemical panels. Recently, Arginase-1 (ARG-1) and Glypican-3 (GPC-3) have been introduced for differentiation of these tumors.

Objectives:

The aim of this study was to determine the diagnostic accuracy of ARG-1 and GLP-3 in differential diagnosis of liver tumors.

Patients and Methods:

Eighty-nine formalin-fixed paraffin-embedded tissue blocks including 43 cases of documented HCCs, 19 cases of documented CC, and 27 cases of MA involving the liver (15 colon, 5 stomach, 3 pancreas, 2 gallbladder, 1 duodenum and 1 ampulla of vater) were evaluated for immunohistochemical expression of ARG-1 and GPC-3.

Results:

Arginase-1 and GPC-3 demonstrated diffuse staining, as reactivity in > 97% of HCCs, whereas only one (5.3%) and 2 (10.5%) of 19 CC cases show positive staining for GPC-3 and ARG-1, respectively. The expression of both markers in MA showed 6 (22.2%) for ARG-1 and 3 (11.1%) for GPC-3, especially with colorectal origin. Our findings showed a statistically significant difference between ARG-1 and GPC-3 expression in HCC, CC and MA.

Conclusions:

The findings of this study reveal that both ARG-1 and GPC-3 are helpful IHC markers to separate HCC from CC and MA. Furthermore, ARG-1 shows 100% sensitivity and 82.6% specificity for the diagnosis of HCC whereas GPC-3 demonstrated 97.7% sensitivity and 91.3% specificity for the diagnosis of this tumor.     

主动脉夹层动脉瘤的螺旋CT诊断

为评价主动脉夹层动脉瘤的螺旋CT表现及诊断价值 ,选择 2 3例主动脉夹层动脉瘤患者共进行了 2 5人次螺旋CT检查 ,层厚 10mm、螺距为 1.5。CT影像表现按特异性和非特异性征象进行分析。结果发现 ,特异性征象显示 :主动脉真假双腔 2 2例 (95 .7% ) ,分离移位的内膜瓣 2 2例 (95 .7% ) ;非特异性征象显示 :主动脉不规则扩张 2 3例 (10 0 % ) ,主动脉壁增厚钙化 2 1例 (91.3% ) ,附壁血栓 4例 (17.4% ) ,诊断准确率 95 .7%。提示螺旋CT是评价和诊断主动脉夹层动脉瘤有效的影像学检查方法。     

Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.