单中心HNF1A失活型肝细胞腺瘤临床病理特征

目的：分析并总结HNF1A失活型肝细胞腺瘤临床病理特征,以提高此类肿瘤的认识。材料：收集2002至2017年复旦大学附属中山医院经手术切除并诊断为肝细胞腺瘤病例,经免疫组化分型后整理并回顾性分析HNF1A失活型肝细胞腺瘤的相关临床资料及观察形态学特点。结果：在2002至2017年确诊为肝细胞腺瘤102例,依据免疫组化染色结果,其中17例为HNF1A失活型肝腺瘤(LFABP－、β-catenin－、GS－、CRP－、SAA－),约占17%。女性患者与男性患者比例为13:4,平均年龄为33岁,均无糖尿病、糖原累积症及饮酒史,1位患者曾服用2个月避孕药,1位患者感染HBV。肿瘤多为单发(12/17),且形态学多为脂肪变性(12/17)。结论：HNF1A失活型肝腺瘤为肝细胞腺瘤亚型之一,较少恶变为肝细胞肝癌,在肝腺瘤病病例中,要警惕肿瘤异质性并密切随访。     

肝细胞腺瘤同时合并肝外肿瘤2例超声造影表现

正1资料肝细胞腺瘤(hepatocellular adenoma,HCA)是少见的肝脏良性肿瘤,HCA同时合并肝外肿瘤未见相关报道。现对复旦大学附属中山医院2009年10月—2019年2月收治的2例HCA同时合并肝外肿瘤患者的超声表现及临床病理学资料进行分析,旨在提高HCA的术前诊断率,为临床治疗提供依据。     

早发糖尿病合并肝囊肿家系肝细胞核因子1β基因的突变研究

目的探讨早发糖尿病合并肝囊肿家系临床表型与肝细胞核因子(hepatocyte nuclear factor,HNF)1β基因突变的关系,以明确糖尿病合并肝囊肿与青少年起病的成人型糖尿病(MODY)5亚型的关系。方法采集9例早发糖尿病合并肝囊肿家系先证者及16例健康对照者外周血样,提取基因组DNA,应用聚合酶链式反应(Polymerase Chain Reaction,PCR)技术对HNF1β基因序列扩增并测序分析,如先证者发现突变,则进一步对其家属进行研究。结果 9例先证者均未发现HNF1β基因编码区突变,但发现6种非编码区多态性,分别为:IVS7-115G>A,IVS8+102G>A,IVS8+155delA,IVS9-22T>C,+99A>C,+100G>A。其中+99A>C仅见于一个先证者及其子,在对照组没有发现;余5种多肽变异同时出现在患病组和健康对照组。结论该9个早发糖尿病合并肝囊肿家系不是MODY5家系。HNF1β基因下游调控序列+99A>C变异可能与早发糖尿病合并肝囊肿相关。     

肝细胞腺瘤1例报告

1引言 肝细胞腺瘤(hepatocellular adenoma,HCA)是一种相当少见的肝脏良性肿瘤.在普通人群中每年发病率为1/100万,以前常发生于青年女性,特别是长期口服避孕药的妇女,男、女性发生率比值为1:9p[1].1960年口服避孕药问世前,HCA很少被报道,在1954年以前的36年中,5万例尸检病例中只有2例HCA,1973年Baum首次报道HCA与口服避孕药有关[2].以后发现临床上有相当一部分病人没有明显的症状和病因,并且这种无症状和病因的HCA以男性多见.现将我院收治的1例HCA报道如下.     

罕见的小儿巨大肝细胞腺瘤诊治体会

小儿肝肿瘤以肝母细胞瘤为常见 ,我们遇到 1例小儿巨大型肝细胞腺瘤 ,现报告如下。1　病历简介女 ,12岁。2年前因腹胀在当地医院检查发现肝脏巨大肿块 ,经 B超、CT、MRI诊断为巨块型肝癌 (2 5 cm× 2 5 cm×2 0 cm) ,肝、肾功能 ,血浆白蛋白、甲胎蛋白及肝炎病毒标志物检查虽均属正常范围 ,终因肿瘤巨大 ,未施行手术治疗 ,坚持服用中药治疗 ,2年后我院就诊。查体 :神志清楚 ,T 37℃ ,P88次 / m in,R2 8次 / m in,BP90 / 6 8mm Hg(12 / 9k Pa)。无黄疸、贫血、肝掌、蜘蛛痣 ,浅表淋巴结未扪及 ,颈静脉无怒张。心肺无异常。腹膨隆 ,右侧…     

肝细胞腺瘤的诊断及治疗

【目的】探讨肝细胞腺瘤（HCA）的,临床诊断与外科治疗方式。【方法】回顾性研究14例HCA的临床资料并复习文献进行分析总结。【结果】14例病例中1例有口服避孕药史。术前确诊4例,确诊率28．5％（4／14）。1例破裂出血,1例发生癌变。13例无肝炎病史,AFP均正常,影像学检查边界清晰,无癌栓形成。13例经手术治疗。【结论】HCA的术前确诊较困难,影像学检查结合肝炎病史,AFP等检查可以提高诊断率。HCA应积极手术治疗。     

标准与规范

一、酒精性脂肪肝 (一) 换算为日本酒,每日平均饮用3合(每合约=0.18公升)以上,至少持续5年以上的嗜酒者。 (二) 肝病变的主体是约1/3以上肝小叶(全部肝细胞的约1/3以上)脂肪化。 (三) 此外无显著的形态学异常者。 (注) 未实施肝活组织检查,但图象诊断为酒精性 肪肝病例,要另外记载。 二、酒精性肝炎 (一) 嗜酒者。 (二) 过度饮酒后出现急性肝病害临床症状的病例。 (三) 在下述1～2项肝组织学检查所见中,证实有2项以上的病例。 1.酒精玻璃体;2。伴有嗜中性白细胞浸润的肝细胞坏死;3.肝细胞的气球样变化。 (注) 未实施肝活组织检查,证明有上述(一)和(二)而诊断为酒精性肝炎的病例要另外记载 三、酒精性肝硬化 (一) 换算成日本酒,每日饮用5合以上,持续10年以上,或累计饮酒量相当于该量的大量饮酒者。 (二) 根据临床症状特征,或腹腔镜检查和/或肝活组织检查诊断为肝硬化。 (三) 认为酒精是上述2主要原因的病例。 (注) 其中合并肝细胞癌病例,要把情况记下来。     

肝硬化背景下肝癌超声造影增强模式不同的原因分析

目的 探讨肝硬化背景下的肝细胞性肝癌超声造影模式不同的原因.方法 68例伴有肝硬化背景单发性肝细胞性肝癌行超声造影检查后均行穿刺活检取组织送病理组织学检查与流式细胞计(FCM)DNA分析.所有病例根据肝背景及癌细胞的增殖状态分为A1组18例(代偿性肝硬化伴低增殖组)、A2组21例(代偿性肝硬化伴高增殖组)、B1组17(失代偿性肝硬化伴低增殖组)及B2组12例(失代偿性肝硬化伴高增殖组),比较不同程度肝硬化背景、不同增殖状态肝癌的增强持续时间,对比各组肝背景与肝癌的增强持续时间.结果 代偿性肝硬化背景的增强持续时间明显比失代偿性肝硬化背景的长,低增殖状态肝癌的增强持续时间较高增殖状态的肝癌长,A1组、A2组及B2组肝背景的增强持续时间均比肝癌的长,B1组肝背景的增强持续时间与肝癌的无统计学差异意义.结论 不同程度肝硬化背景及不同生物学活性肝癌的增强持续时间不同造成肝癌超声造影模式不同,因此诊断时需考虑病灶自身及肝背景的影响.     

肝动脉结扎术治疗肝癌的体会

临床资料我院自1976年1月～1979年5月对不能切除的肝癌行肝动脉结扎术共14例(男12,女2)。不能切除的原因:癌灶散在分布于肝左右两叶8例,肿瘤位于肝门区3例,肿瘤侵及胰腺、膈肌各1例,腹腔动脉周围有淋巴结转移1例。肿瘤直径为4～10厘米,大多数为多个病灶,14例均经病理证实为原发性肝细胞肝癌。8例甲胎蛋白火箭电泳自显影测定大于400毫微克/毫升。全部病例采用肝固有动脉结扎     

肝细胞腺瘤的MSCT表现

肝细胞腺瘤(hepatocellular adenoma,HCA)在肝脏良性肿瘤中发病率仅低于肝血管瘤,临床却远比血管瘤少见[1].HCA易出血、破裂导致急腹症,甚至危及生命,而其临床症状和体征缺乏特异性,不易与肝脏其他良、恶性肿瘤相鉴别.本文回顾性分析5例HCA的MSCT三期扫描影像表现,结合相关文献,讨论HCA的影像特点.     

肝局灶性结节增生患者血浆miR-21的表达及鉴别诊断价值

目的:探讨血浆miR-21的表达及对肝脏局灶性结节增生(focal nodular hyperplasia,FNH)、肝腺瘤(hepatocellular adenoma,HCA)和甲胎蛋白(alpha-fetoprotein,AFP)阴性肝细胞肝癌(hepatocellular carcinoma,HCC)的鉴别诊断...     

Contrast-enhanced agent detection imaging: Early experience in hepatocellular carcinoma

Purpose: To investigate the usefulness of contrast-enhanced Agent Detection Imaging in assessing intratumoral vasculature in hepatocellular carcinoma.Materials and Methods: Fourteen hepatocellular carcinoma nodules in 11 patients were studied with contrast-enhanced Agent Detection Imaging, a wide-band color Doppler imaging method, employing, Levovist^?, a microbubble contrast agent. High acoustic power was used with contrast-enhanced Agent Detection Imaging. Intermittent transmission of Agent Detection Imaging was performed at intervals of 200, 500, and 350 milliseconds in the early arterial phase (10 to 40 seconds), late vascular phase (1 to 3 minutes) and postvascular phase (5 to 7 minutes), respectively. The results were compared with those of three-phase dynamic CT.Results: Intratumoral blood vessels in the early arterial phase and tumor parenchymal stain in the late vascular phase were depicted in 12 (88%) of the 14 hepatocellular carcinoma nodules, while all nodules were demonstrated as perfusion defect in the postvascular phase on contrast-enhanced Agent Detection Imaging. The results of Agent Detection Imaging, that were compared with those of dynamic CT, were all 100% : diagnostic sensitivity (12/12), specificity (2/2), and accurary (14/14).Conclusion: Contrast-enhanced Agent Detection Imaging is a promising method for depicting intratumoral vascularity in hepatocellular carcinoma.     

Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images

Purpose

To explore the value of CT texture analysis (CTTA) for differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) on contrast-enhanced CT (CECT).

Methods

This is a retrospective, IRB-approved study conducted in a single institution. A search of the medical records between 2008 and 2017 revealed 48 patients with 70 HCA and 50 patients with 62 FNH. All lesions were histologically proven and with available pre-operative CECT imaging. Hepatic arterial phase (HAP) and portal venous phase (PVP) were used for CTTA. Textural features were extracted using a commercially available research software (TexRAD). The differences between textural parameters of FNH and HCA were assessed using the Mann–Whitney U test and the AUROC were calculated. CTTA parameters showing significant difference in rank sum test were used for binary logistic regression analysis. A p value < 0.05 was considered statistically significant.

Results

On HAP images, mean, mpp, and skewness were significantly higher in FNH than in HCA on unfiltered images (p ≤ 0.007); SD, entropy, and mpp on filtered analysis (p ≤ 0.006). On PVP, mean, mpp, and skewness in FNH were significantly different from HCA (p ≤ 0.001) on unfiltered images, while entropy and kurtosis were significantly higher in FNH on filtered images (p ≤ 0.018). The multivariate logistic regression analysis indicated that the mean, mpp, and entropy of medium-level and coarse-level filtered images on HAP were independent predictors for the diagnosis of HCA and a model based on all these parameters showed the largest AUROC (0.824).

Conclusions

Multiple explored CTTA parameters are significantly different between FNH and HCA on CECT.

     

Effectiveness and safety of irreversible electroporation for recurrent hepatocellular carcinoma ineligible for thermal ablation after surgery

ObjectivesTo preliminarily evaluate the clinical effectiveness and safety of computed tomography (CT) image-guided irreversible electroporation (IRE) for the treatment of recurrent hepatocellular carcinoma (HCC) after surgical resection.MethodsFrom January 2016 to February 2018, 18 patients diagnosed with recurrent HCC after surgical resection received IRE under CT image guidance for 22 tumors. Patients were enrolled for IRE when ineligible for thermal ablation due to tumor location. Clinical records and imaging data were reviewed to assess complete ablation rate, local tumor progression free rate (LTPFR), local tumor progression free survival (LTPFS) and complications after a median follow-up time of 14 months.ResultsSuccessful complete ablations were achieved in 20/22 (90.1%) tumors. Mean LTPFS was 10.5 ​± ​9.4 months. Overall 3-, 6- and 12-months LTPFR in 22 tumors following IRE were 68.2% (95% confidence interval [CI]: 45%–83%), 59.1% (95% CI: 33%–76%) and 36.4% (95% CI: 17%–56%), respectively. Complications included pneumothorax (2/18, 11.1%), localized pain (3/18, 16.7%), bile duct dilation (1/18, 5.6%) and transient hypertension (1/18, 5.6%). No major complications or treatment-related deaths were observed. The alpha-fetoprotein levels of two patients decreased to the normal range at 3 and 4 months, respectively.ConclusionsThis study showed that percutaneous CT image-guided IRE can serve as a safe and effective treatment for recurrent HCC not suitable for thermal ablation.     

不同病理分型混合型肝癌的超声造影特征分析

目的:观察混合型肝癌(CHC)的临床及超声造影特征,并探讨不同病理分型CHC的超声造影表现差异.方法:回顾性分析经手术病理确诊为CHC患者的临床病理及超声图像,总结其超声造影特征并对不同病理分型CHC的超声造影表现进行比较.结果:共纳入49例CHC患者,其中经典型27例,以HCC成分为主型21例,以ICC成分为主型25...     

基于5.0T MRI的磁敏感加权成像诊断肝细胞癌合并静脉癌栓

目的 观察基于5.0T MRI的磁敏感加权成像(SWI)诊断肝细胞癌(HCC)合并静脉癌栓的价值。方法 回顾性分析63例HCC患者,其中17例合并静脉癌栓; 观察5.0T SWI检出静脉癌栓的效能,比较5.0T与3.0T 图像质量。结果 5.0T SWI显示16例癌栓,未能检出1例位于门静脉左支左外叶上段的癌栓。5.0T增强MRI门静脉期和肝胆期图像显示肝脏边缘评分、整体图像质量评分、信噪比和对比度噪声比均高于3.0T(P均<0.05)。结论 5.0T SWI有助于诊断HCC合并静脉癌栓。     

肝脏局灶性病变18F-FDG PET/CT与PET/MR比较分析

目的 比较¹⁸F-FDG PET/CT与PET/MR显像对肝脏局灶性病变（FLLs）的临床应用价值。方法 回顾性分析41例FLLs患者的临床资料、¹⁸F-FDG全身PET/CT及上腹部MR扫描图像。比较CT、MRI、PET、PET/CT及PET/MR对FLLs的检出率。结果 41例FLLs患者中共检出69个病灶,包括肝脏良性病灶22个、肝细胞癌（HCC）17个、转移瘤30个。CT、MRI、PET、PET/CT及PET/MR对FLLs的总体检出率分别为72.46%（50/69）、94.20%（65/69）、55.07%（38/69）、79.71%（55/69）及100%（69/69）。PET/MR对肝脏良性病灶及HCC的检出率（22/22,100%;17/17,100%）均高于PET/CT（13/22,59.09%;12/17,70.59%;P均<0.05）,二者对转移瘤的检出率均为100%（30/30）。结论 PET/MR对FLLs的检出率较高,具有良好的临床应用价值。     

Expression of SET domain bifurcated histone lysine methyltransferase 1 and its clinical prognostic significance in hepatocellular carcinoma

BackgroundTo detect the expression of histone methyltransferase SETDB1 in hepatocellular carcinoma, and to analyze the relationship between SETDB1 expression and tumor size, microvascular invasion, pTNM stage, gender, age, tumor number, tumor differentiation, and other clinicopathological characteristics.MethodsImmunohistochemical method was used to detect the expression of SETDB1 proteins in liver cancer tissues and adjacent tissues of 100 cases. The qRT‐PCR method was used to detect the expression of SETDB1 mRNA in hepatocellular carcinoma and adjacent tissues of 64 cases.ResultsThe expression of SETDB1 protein and mRNA in hepatocellular carcinoma was higher than that of adjacent normal liver tissue (p < 0.05). High protein expression of SETDB1 was associated with tumor size, MVI presence, and pTNM stage (p < 0.05). Univariate analysis revealed that the tumor size, tumor differentiation, MVI grade, and pTNM stage were correlated with DFS, while tumor size, MVI grade, pTNM stage, and SETDB1 protein expression were correlated with OS. Multivariate analysis showed that the combination of MVI grade and pTNM stage has statistical significance in predicting prognosis, while SETDB1 protein expression was not significant prognosis factor.ConclusionsSETDB1 has a certain role in HCC progression and may act as a prognostic predictor concerning the survival of HCC patients.     

胆囊癌根治术后复发因素分析及放疗靶区指导

目的:探讨胆囊癌根治术后复发因素及复发模式,为术后辅助放疗靶区提供依据。方法:回顾性分析复旦大学附属中山医院2008—2018年收治的102例胆囊癌并接受根治术患者病例资料,明确复发因素及复发模式(包括瘤床/腹腔淋巴结复发)。其中术后辅助化疗37例,未化疗65例。结果:根治术后中位区域复发时间为12.4个月。单因素分析显示,pT、pN、黏液成分、分化与区域复发相关(P0.05)。pT、pN、分化与瘤床复发相关(P0.05);pT、pN、神经脉管侵犯与腹腔淋巴结复发相关(P0.05)。多因素分析显示,pT、pN是胆囊癌根治术后区域复发的独立预测因子(P0.05)。中位瘤床复发时间为12.5个月(95%CI 8.4～16.5个月)。中位腹腔淋巴结复发时间为10.9个月(95%CI 8.1～13.7个月)。pT/pN是瘤床复发和腹腔淋巴结复发的独立预测因子(P0.05)。术后腹腔淋巴结复发分布:8、12a、16b1高复发(40%);9、12p、13、16a2次之(20%～30%);3、5、6、7、14、16b2、17、18组较少(10%)。结论:胆囊癌根治术后复发率高,pT/pN是影响复发独立因素。即使D1淋巴结清扫,腹腔淋巴结复发仍多见。建议放疗靶区包括瘤床及部分腹腔淋巴结(8、9、12a、12p、13、16a2、16b1)。