【摘要】 目的 探討肝臟血管平滑肌脂肪瘤（hepatic angiomyolipoma，HAML）的多層螺旋CT影像學表現特征及其與病理學基礎的相關性，以進一步提高CT診斷的準確性。 方法 收集2008年11月-2010年12月經手術病理證實的16例HAML患者。所有患者均行螺旋CT平掃及動脈期、門脈期增強檢查，重點觀察HAML的分型及其相應CT表現及影像-病理的相關性。 結果 16例患者共20個病灶，19個為稍低密度病灶，其中11個病灶內可見明顯的脂肪密度影；1個為稍高密度病灶。動脈期所有病灶均有不同程度的強化表現，15個病灶內可見到較明顯條狀及扭曲的血管影。門脈期15個病灶有持續強化。 結論 多層螺旋CT能準確反映HAML的分型及其病理特征，對臨床表現不典型患者的診斷和鑒別診斷有較大診斷價值。【Abstract】 Objective To discuss the correlation between the features of multislice spiral CT results for hepatic angiomyolipoma (HAML) and their pathological basis, and to further improve the diagnostic accuracy through CT examination. Methods Sixteen HAML patients diagnosed pathologically between November 2008 and December 2010 in our hospital were enrolled in our study. All patients underwent multi-slice spiral CT scanning of pre-and post-contrast arterial phase, and portal venous phase. Focus was put on observation of HAML types and their corresponding manifestations, and the correlation between CT imaging and the pathologic basis. Results There were 20 lesions in the 16 patients. Among the 19 hypodense lesions, 11 were clearly seen with fat density shadow. One out of the 20 lesions showed as slightly hyperdense. On the arterial phase scanning, all lesions showed enhancement, and obvious vascular shadow could be seen in15 lesions. On the portal venous phase, 15 lesions continued to strengthen. Conclusions Multi-slice spiral CT can accurately reflect the classification of HAML and its pathological features. It has a great value in the diagnosis and differential diagnosis of patients without typical clinical manifestations.
Objective?To evaluate the value of various CT features in differentiating renal angiomyolipoma (RAML) with minimal fat and renal cell carcinoma (RCC). Methods?The Cochrane Library, PubMed, MEDLINE (OVID), EMBase, and the Chinese Periodical Wed (CNKI, CBM, VIP) were searched. They were searched from Jan 2001 to Nov 2008. Trials screening, quality assessment, and data extraction was conducted according to the inclusion criteria recommended by the Cochrane Collaboration. The SROC curve and meta-analyses were performed by Meta-disc 1.4. Results?Seven trials, involving 482 patients and 513 tumors, were included. The studies were highly homogonous. It was considered that 8 features including single or multiple lesions, scanning density, calcification, angle with cortex, levering-cortex-up sign, lesions pro-trusion, homogeneous enhancement, and prolonged enhancement, played certain roles in differentiating RAML with minimal fat and RCC. Among these features, interface with the cortex was the most important, and the features of homogeneous enhancement and prolonged enhancement were the second most important. Conclusion?Besides measuring lipoid tissue in the tumor, there are another 8 features which are valuable to the differentiation of RAML with minimal fat and RCC.
【摘要】目的探討肝血管平滑肌脂肪瘤的臨床病理特點、診斷及鑒別診斷。 方法對3例肝血管平滑肌脂肪瘤患者有關病理檢查結果進行回顧性分析。 結果腫瘤位于肝右葉2例，肝左葉1例。腫瘤直徑為2～10 cm，平均6.2 cm。3例腫瘤內均見平滑肌、脂肪、畸形厚壁血管，但未見髓外造血灶。對黑色素瘤（HMB45）、結合蛋白（desmin)及肌動蛋白（actin)檢查均呈陽性反應。術后隨訪6～36個月，未見腫瘤復發。結論肝血管平滑肌脂肪瘤由3種成分組成，病理形態變化多樣，必須與多種肝腫瘤相鑒別。平滑肌細胞HMB45表達呈強陽性反應是診斷肝血管平滑肌脂肪瘤較可靠的依據。
ObjectiveTo summarize clinicopathologic and immunophenotypic features of hepatic epithelioid angiomyolipoma (HEAML) and to explore its diagnostic and differential diagnostic methods.MethodThe clinical and imaging manifestations, pathological morphology and immunohistochemical features of 5 patients with HEAML from August 2011 to December 2017 in this hospital were retrospectively analyzed.ResultsThere were 2 males and 3 females in the 5 patients with HEAML, aged 38–64 years with an average age of 50 years. There were 2 cases of the left lobe tumors and 3 cases of the right lobe tumors. Three cases were diagnosed as the hepatocellular carcinoma and the other two cases were diagnosed as the hepatic hamartoma and (or) hemangioma by the preoperative imaging examination. The diameter of tumors ranged from 1.5 cm to 7.0 cm, with an average of 3.6 cm. Microscopically, the tumors were composed of more epithelioid smooth muscle cells, parenchyma vessels and a small amount of fat. The immunohistochemical results showed that the melan-A, HMB45, and SMA were positive, while the HepPar-1, AE1/AE3, EMA, CD117, Dog-1, CD10, CgA, Syn, and Desmin were negative. The Ki-67 proliferation index was 2%–10%. The patients were all alive without the tumor recurrence after following up for 2–76 months with an average of 31.4 months.ConclusionsHEAML is a rare primary mesenchymal tumor of liver, which should be misdiagnosed for other benign or malignant tumors for influencing clinical treatment. Diagnosis and differential diagnosis can be made by histopathology and immunohistochemical staining.
【摘要】 目的 探討腎上腺髓樣脂肪瘤的彩色多普勒超聲表現和超聲診斷價值。 方法 回顧性分析2005年3月-2010年9月58例61個經手術及病理證實的腎上腺髓脂肪瘤病灶的彩色多普勒超聲表現，對病變的大小、內部回聲特點及血流特點進行分析。 結果 在2005年3月-2007年12月的28個病灶超聲診斷出腎上腺病變23個，正確率82.1%；診斷為髓脂肪瘤2個，正確率7.1%；漏診1個，誤診4個。2008年1月-2010年9月，33個病灶超聲診斷出腎上腺病變30個，正確率90.9%；診斷為髓脂肪瘤19個，正確率57.6%；無漏診，誤診3個。52個病灶超聲表現為邊界清晰，形態基本規則，內部呈均勻中等強回聲（與腎集合系統回聲相當），內部未測及血流信號， 另8個病灶表現為中等強回聲與低回聲相間。 結論 腎上腺髓樣脂肪瘤具有特征性的彩色多普勒超聲聲像圖表現， 可用于發現病變并對多數腎上腺髓樣脂肪瘤做出定性診斷。【Abstract】 Objective To evaluate the value of sonographic diagnosis of adrenal myelolipoma. Methods Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed. Results In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected. Conclusion Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.