肝局灶结节性增生的影像学特征及临床病理观察

目的:探讨肝局灶结节性增生(FNH)的临床及影像学特点、病理形态、免疫组织化学特征及鉴别诊断。方法:分析9例FNH的临床资料及发病特点、影像学特征、组织病理形态及免疫表型、细胞角蛋白(CK8/18、CK7)、CD34、甲胎蛋白和Ki-67的表达。并进行相关文献复习。结果:影像学观察FNH通常为孤立的结节,平扫为等密度或稍低密度,中央可见低密度瘢痕。FNH病理大体表现为境界清楚、中央有纤维瘢痕的结节性肿块。镜下纤维间隔将肝组织分割成大小不等、形状不规则的结节,可见厚壁血管及增生的小胆管。免疫组织化学染色CK8/18、CK7结节内和周边增生的小胆管阳性表达;CD34结节内的血窦内皮细胞及纤维间隔的血管内皮细胞阳性表达。甲胎蛋白结节内增生胆管和肝细胞均阴性,Ki-67阳性指数较低。结论:FNH是对畸形血管的肝细胞反应性增生,是一种良性瘤样病变,对于诊断明确的无症状者手术切除后,可定期随诊或复查。

Imaging features and clinicopathologic study of hepatic focal nodular hyperplasia

Objective:To explore the clinical and imaging charteristics, pathological immunohistochemical features and differential diagnosis of hepatic focal nodular hyperplasia( FNH) . Methods:Nine cases of hepatic FNH were analyzed by means of clinicopathologic data analysis, imaging features, histopathology, immunophenotype, cytokeratin 8/18 and cytokeratin 7,α-fetoprotein and Ki-67. In addition,the related literature was reviewed. Results:The imaging demonstrated a solitary nodular,and the plain scan showed isodensity or slightly low density with a low density scar in the centre. Hepatic FNH was a tumor presenting a clear realm and having a mass nodular fibrous scar in the centre. The liver tissue was divided into unequal and irregular nodules by the fibrous scar;thick wall vessels and proliferation of the bile ducts could be seen. Hepatic FNH showed positive immunostaining of cytokeratin 8/18 and cytokeratin 7 in the small bile ducts within the nodule and partial liver cells surrounding. CD34 was positively expressed on blood sinus endothelial cells of the nodules and fiber interval. Both the hyperplasia bile ducts and the liver cells were negative forα-fetoprotein and lowly expressed for Ki-67. Conclusions:FNH is widely recognized as a hyperplasia reaction of live cells to vascular malformations;therefore,hepatic FNH is a kind of benign tumor-like lesion. Asymptomatic persons with clear diagnosis should be followed-up regularly and reviewed after operation excision.