8例原发性肝脏血管肉瘤患者的CT表现及病理分析

目的分析8例原发性肝脏血管肉瘤(PHA)的CT表现及相关病理特点,以提高该病的CT诊断。方法所有病例均经手术病理证实,CT上腹部平扫后行动脉期、门脉期、延迟期增强扫描,观察PHA患者的CT表现。手术切除标本,常规HE染色及免疫组织化学染色,常规显微镜观察。结果 CT平扫8例,5例为巨块型,2例混合型,1例多发结节型。病灶呈不均匀低密度影,中央见更低密度坏死区,其中4例巨块型低密度内见散在小片状高密度影,1例混合型巨块边缘见高密度结节。动脉期7例周边结节状、不规则强化,其中1例中央亦见点絮状强化,1例无明显强化。门脉期及延迟期病灶持续强化,1例病灶始终未见强化。本组9个病灶中5个病灶动脉期及门脉期边缘清晰,与周围正常肝组织界限如同"刀切样"表现。7个病灶外缘在门脉期发现"假包膜"。结论 PHA的CT表现为大片低密度灶内伴不规则坏死区或是散在出血灶,增强检查呈渐进性充填,中央有坏死区,边缘可见"刀切征"和"假包膜征",通过上述特征性表现,有助于提高诊断率。

CT and pathological features of primary hepatic angiosarcoma

Objective To present the computed tomography （CT）findings and associated pathological features of eight cases of primary he-patic angiosarcoma （PHA）.Methods All cases were confirmed by pathology.After a CT scan of the upper abdomen,all cases of PHA un-derwent enhanced scans in the arterial phase,portal venous phase,and delayed phase to observe the CT manifestations.The surgical speci-mens were subjected to conventional hematoxylin-eosin staining and immunohistochemistry and observed under a microscope.Results Of all patients,5 cases were massive type,2 cases were mixed type,and 1 case was multiple nodule type.CT scans revealed inhomogeneous low-density lesions,with necrosis of even lower density in the central part.In 4 cases of massive type,scattered high-density small pieces were observed in low-density areas;in one case of mixed type,high-density nodules were observed on the edge of mass.There were 7 ca-ses of peripheral nodular irregular enhancement in the arterial phase,including 1 case with flocculent central enhancement and another with no enhancement.Lesions remained enhanced in the portal venous and delayed phases,but 1 case had no enhancement.Five in 9 lesions had sharp edges in the arterial and portal venous phases,with“sharpen rim perpendicular to pleura”signs at the boundaries with the surrounding normal liver tissue.The outer edges of 7 lesions were found to have “pseudocapsules”in the portal venous phase.Conclusion CT scans showed a large hypodense lesion with irregular necrotic areas or scattered hemorrhage in PHA patients,whist enhanced scans showed a pro-gressive filling and necrotic area in the central part.There could be“sharpen rim perpendicular to pleura”and“pseudocapsule”signs at the edge.It might be helpful to improve the diagnosis through the above characteristic features.