原发性肝透明细胞癌的影像学表现与临床病理对照

目的探讨原发性肝透明细胞癌(PCCCL)的影像学表现。方法回顾性分析12例经手术病理证实的PCCCL患者的临床及影像学资料,并复习文献。7例行CT平扫和动态增强扫描,8例行MR T1WI,T2WI,DWI和动态增强扫描。结果 12例患者均为男性;10例有乙肝病史,HBsAg(+);6例甲胎蛋白(AFP)阳性,11例为单发病灶,其中10例位于肝右叶,1例位于肝左叶,1例肝内播散;病灶多呈类圆形,边界较为清楚,以实性成分为主。CT平扫呈不均匀等或低密度影,其中2例病灶内部见不规则的更低密度影。增强后动脉期均呈不均匀强化,2例病灶有无强化的低密度区,门静脉期强化程度下降,呈相对低密度,延迟期病灶密度进一步减低。MRI T1WI上病灶多呈低信号,T2WI呈等或不均匀高信号,DWI呈高信号。增强动脉期呈较为明显不均匀强化,动脉期强化较为明显,门静脉期强化程度相对下降,其中2例病灶见环形强化的假包膜。延迟扫描病灶呈低信号。免疫组织化学结果,肿瘤细胞PAS、Hep Par1染色均为阳性,CD10,CA-50多数阳性,但p53及CerbB-2染色均为阴性。结论 PCCCL的影像学表现较为复杂,诊断需结合相关临床资料,确诊依赖病理。

Primary clear cell carcinoma of the liver:imaging findings and clinical pathology

Objective To explore the imaging findings of primary clear cell carcinoma of the liver(PCCCL). Methods The clinical pathological data and imaging findings of 12 cases with pathologically proven PCCCL were analyzed retrospectively and the literature was reviewed.Both non-contrast and contrast scans with spiral CT were performed in 7 cases,MRI with T1WI,T2WI,DWI and dynamic multiphase contrast scanning were performed in 8 cases. Results All 12 cases were males,10 of them had a history of hepatitis B and HBsAg(+),6 cases showed positive AFP;11 cases had single lesion with solid part mainly,the shape of most tumors was oval and the boundary was clear.10 cases were located in right lobe and 1 in left,one case with intrahepatic spread.The lesions showed isodense or hypodense on non-contrast CT scans and enhanced heterogeneously on the arterial phase in which two cases with central non-enhanced area.Lower enhancement was found in the portal venous phase and further lower in the delayed phase. Most lesions were hypointense on MRI T1WI,heterogeneously hyperintense on T2WI and hyperintense on DWI.All lesions were found marked enhancement on the MR arterial phase and relatively hypointense on the portal venous phase,in which 2 cases were found pseudocapsule with rim enhancement.And on the delayed phase,the lesions were hypointense.Immunohistochemically,tumor cells showed positive for PAS,Hep Par1,mostly CD10,CA-50 and negative for p53,CerbB-2. Conclusion PCCCL's imaging findings is comparatively complex,the diagnosis should be combined with the relevant clinic data,the final diagnosis depends on pathology.