肝海绵状血管瘤合并结节性再生性增生误诊为肝癌合并肝硬化1例报告并文献复习

背景与目的：肝海绵状血管瘤是最常见的肝脏原发肿瘤。尽管通过影像学检查，针对该病的诊断程序已经非常成熟，但在罕见疾病组合的情形中仍有被误诊为肝细胞癌的风险。本文通过回顾1例术后被诊断为海绵状血管瘤合并结节性再生性增生的肝移植病例，分析诊疗过程中的关键疑难点，复习海绵状血管瘤和结节性再生性增生的临床病理特征以及其与肝细胞癌和肝硬化的鉴别要点，旨为今后临床工作提供经验与教训。方法：回顾性分析武汉大学中南医院收治的1例肝移植患者的临床病史资料、影像学特点及病理组织学诊断，结合国内外文献中肝海绵状血管瘤和结节性再生性增生的特点，对本病例诊疗过程进行分析和归纳。结果：患者，男性，71岁，因腹水及肝右叶占位性病变入院。影像学检查提示肝硬化、腹水及肝右叶占位性病变。全腹部CT平扫和增强诊断肝硬化合并肝细胞癌。经全科会诊与患者充分沟通后，患者进行了肝移植术。术中检查和术后大体检查发现肝脏呈弥漫结节性改变伴肝右叶占位性病变。组织学发现前者为结节性再生性增生，而占位性病变则为海绵状血管瘤。结论：通常情况下肝海绵状血管瘤不存在影像学诊断困难，但在弥漫结节性背景下，海绵状血管瘤仍可被误诊为肝细胞癌。结节性再生性...

Misdiagnosis of hepatic cavernous hemangioma combined with nodular regenerative hyperplasia as hepatocellular carcinoma and cirrhosis: a case report and literature review

Background and Aims Hepatic cavernous hemangioma is the most common type of benign liver tumor. Despite the maturity of diagnostic procedures for this disease through imaging examinations, there is still a risk of misdiagnosis as hepatocellular carcinoma in cases of rare disease combinations. This article aims to provide experience and lessons for future clinical work by reviewing a case of liver transplantation diagnosed postoperatively as cavernous hemangioma combined with nodular regenerative hyperplasia, analyzing the key difficulties in the diagnosis and treatment process, reviewing the clinicopathologic characteristics of cavernous hemangioma and nodular regenerative hyperplasia, as well as their differential points from hepatocellular carcinoma and liver cirrhosis.Methods The clinical history, imaging features, and histopathological diagnosis of one liver transplant patient admitted to Zhongnan Hospital of Wuhan University hospital were retrospectively analyzed, and the diagnosis and treatment process of this case were summarized in combination with the characteristics of hepatic cavernous hemangioma and nodular regenerative hyperplasia in domestic and foreign literature.Results The patient was a 71-year-old male admitted for ascites and a space-occupying lesion in the right lobe of the liver. Imaging examinations suggested liver cirrhosis, ascites, and a space-occupying lesion in the right lobe of the liver. Abdominal CT scan and enhancement diagnosed liver cirrhosis combined with hepatocellular carcinoma. After comprehensive consultation and sufficient communication with the patient, liver transplantation was performed. Intraoperative examination and postoperative gross examination revealed diffuse nodular changes in the liver with a space-occupying lesion in the right lobe of the liver. Histologically, the former was nodular regenerative hyperplasia, while the space-occupying lesion was cavernous hemangioma.Conclusion Generally, hepatic cavernous hemangioma does not present difficulties in imaging diagnosis. However, cavernous hemangioma can still be misdiagnosed as hepatocellular carcinoma in a diffuse nodular background. Nodular regenerative hyperplasia is a rare and heterogeneous benign liver lesion with clinical features very similar to liver cirrhosis, and differentiation from the latter depends on pathological diagnosis. Even though authoritative guidelines propose that hepatocellular carcinoma can be diagnosed with imaging alone in the background of liver cirrhosis, in particular scenarios, a pre-transplantation biopsy is still required to confirm the diagnosis.