肝胰原发性恶性纤维组织细胞瘤的CT诊断

目的:探讨肝胰原发性恶性纤维组织细胞瘤(MFH)的CT表现。方法:回顾性分析经手术和病理证实的4例肝MFH和1例胰MFH的CT表现。病理分型:1例为黏液型,4例为多形性型。5例均采用CT平扫和双期增强扫描,其中2例进行了延迟扫描。结果:5例肿瘤最大径6.8~22.5cm,其中位于肝右叶1例,肝左叶3例,胰尾部1例。CT平扫:1例表现为巨大囊性结构为主的肿块,有包膜,边界清楚;4例表现为不规则形低密度肿块,边界不清。增强扫描:动脉期示肿瘤实质呈轻度~明显强化,2例肿瘤内可见细小血管;静脉期肿瘤呈中度~明显强化,肿瘤内坏死区和肿瘤实质显示清晰,边界清楚;延迟期2例示病灶密度稍低于肝实质。5例中合并肝内转移1例,肝内胆管轻度扩张2例,侵犯膈肌2例,腹膜后淋巴结转移1例。术前CT诊断为恶性肿瘤4例,良性病变1例。结论:肝胰MFH的主要CT表现为肿瘤内坏死显著,局部浸润性强,其CT表现与病理所见有很好的一致性。

CT Diagnosis of Primary Malignant Fibrous Histiocytoma of the Liver and Pancreas

Objective:To evaluate the CT findings in primary malignant fibrous histiocytoma (MFH) of liver and pancreas.Methods:The CT appearances in four cases of hepatic MFH and one case of pancreatic MFH confirmed by surgery and pathology were analyzed retrospectively.The pathology subtypes included myxoid type (n=1) and pleomorphic type (n=4).Pre-contrast and dual-phase contrast enhanced scans were undertaken in all five cases,delayed scanning in two cases additionally.Results:The maximum dimension of tumor ranged from 6.8~22.5cm.Tumor located within the right hepatic lobe (n=1),left hepatic lobe (n=4) and pancreatic tail (n=1).On pre-contrast images,tumor appeared as a large,well-defined,encapsulated,predominantly cystic mass (n=1),and ill-defined,irregular shaped,hypo-attenuated mass (n=4).After contrast enhancement,the solid component of the tumor showed mild to marked enhancement on the arterial phase images,small fine arteries were revealed (n=2).On the portal phase images,tumors showed moderate to marked enhancement,the solid component of tumor and intra-tumoral necrosis could be clearly assessed.The degree of enhancement was less intense than the surrounding liver parenchyma on the delayed phase images in two cases.One metastatic nodule in the right hepatic lobe (n=1),mild dilated intra-hepatic bile ducts (n=2),tumor invaded diaphragm via the liver capsule (n=2) and enlarged retroperitoneal lymph node metastasis (n=1) were seen.Before surgery,the CT diagnosis was malignant tumor (n=4),and benign lesion (n=1).Conclusion:CT findings of primary hepatic and pancreatic MFH include obvious intra-tumoral necrosis and marked local invasiveness,which were correlated well with pathologic findings.