原发性肝脏恶性纤维组织细胞瘤的CT表现

Primary malignant fibrous histiocytoma of the liver:a CT study

目的:分析探讨肝脏恶性纤维组织细胞瘤(MFH)的CT表现,提高对该病的认识。方法:回顾性分析3例经手术病理证实的肝脏MFH的CT及临床资料。3例患者均行上腹部CT平扫、三期动态增强扫描。结果:3例肝脏MFH体积均较大,2例表现为边界尚清晰的单发肿块,1例为边界不清的弥漫性多发瘤灶;瘤内均有不同程度的囊变坏死,无钙化;增强扫描可表现为延迟强化(2例)或快进慢出(1例);1例伴胆管扩张及胆管癌栓。3例均无门静脉癌栓、淋巴结及远处转移。结论:肝脏MFH的CT表现形式多样,临床最终诊断依赖病理,特别需与原发性肝细胞癌或胆管细胞癌鉴别。

Objective：To describe and analyze CT appearances of primary hepatic malignant fibrous histiocytoma（MFH） of the liver.Methods：A retrospective analysis of clinical data and multiphase dynamic CT images was performed in 3 patients with pathologically proven hepatic MFH.Results：Of the 3 patients,all 3 presented with large masses,2 had solitary,relatively well-defined tumors,and 1 had ill-defined infiltrative lesions.Varying degrees of cystic or necrotic changes were seen within all the tumors,but no calcifications were noted.The enhancement pattern of MFH on multiphase dynamic CT was delayed enhancement（n=2） or fast wash-in/slow wash-out（n=1）.One case showed dilatation of intrahepatic bile ducts and thrombi of bile ducts.There was no CT evidence of portal vein thrombosis,regional lymph node involvement or distant metastasis in any of the cases.Conclusion：A definitive CT diagnosis of primary hepatic MFH is challenging because of its variable appearance.Final diagnosis is generally entrusted to pathological findings of surgically resected or biopsy samples.Differential diagnosis must consider several other hepatic malignances,especially hepatocellular carcinoma and intrahepatic cholangiocarcinoma.