原发性巨块型肝癌CT表现与肿瘤细胞分化程度对照分析

Comparative analysis of the correlation between CT finding and cell differentiation in massive type of primary hepalocellular carcinoma

目的探讨原发性巨块型肝细胞癌CT表现与肿瘤细胞分化程度相关性。方法对50例原发性巨块型肝细胞癌螺旋CT表现与病理进行对照分析。膨胀性生长27例中高分化24例,中分化3例;浸润性生长23例均为低分化。结果膨胀性生长27例,CT平扫显示界限清楚,呈团块状不均均匀的低密度,CT值18～30HU,肿块均见坏死囊变,其中瘤内出血11例,假包膜18例,瘤块破裂2例。肝内结节状转移2例,肝门和腹膜后淋巴结转移2例,静脉瘤栓2例。增强扫描见实质病灶呈均匀性强化2例;斑片状、条索状强化9例;瘤灶边缘环形强化9例;瘤灶边缘线形强化7例。浸润性生长23例,CT平扫显示斑片状低密度,CT值23～31HU,其中界限清楚7例,界限不清楚16例,囊变坏死7例,瘤内出血5例,瘤块破裂1例。肝内结节状转移8例,肝门和腹膜后淋巴结转移7例,静脉瘤栓9例。增强扫描见实质病灶呈不均匀性强化2例;散在斑片状、斑点状强化12例;瘤灶边缘环形强化4例;瘤灶边缘线形强化5例。结论 CT征像能反映出原发性巨块型肝细胞癌恶性程度,膨胀性生长的肿瘤细胞分化较好,恶性度较低,预后良好;浸润性生长的肿瘤细胞分化差,恶性度高,预后差。

Objective To discuss the correlation between CT finding and cell differentiation in massive type of primary hepalocellular carcinoma. Methods The findings by CT and pathology in 50 cases of massive type of primary hepalocellu- lar carcinoma were comparatively analyzed in this work. Of these 50 cases, 27 cases exhibited expansive growth, of which 24 presented with high differentiation and 3 with middle differentiation, whereas, 23 exhibited invasive growth, which all presented with low differentiation. Results Among these 27 cases with expansive growth, CT plain scan showed clustered masses with a clear boundary, uneven lower density （about 18~30 HU of CT value）. Areas of necrosis and cyst forma- tion can be seen inside all of the masses, of which, there were 11 cases of hemorrhage, 18 cases of false capsule formation, 2 cases of tumor rupture, 2 eases of intra-hepatic metastasis, 2 cases of metastasis in hilar and retroperitoneal lymph node metastasis, and 2 cases with vein thrombosis. CT enhancement scan showed that 2 presented with homogenous enhance- ment, 9 with patchy and cord-like enhancement, 9 with ring enhancement, 7 with alignment enhancement in edge of tumor lesions of these 27 cases of expansive growth tumors As for these 23 cases with invasive growth tumors, CT plain scan showed the masses with lower patchy density and 23~31 HU of CT value, of which 7 cases presented with a clear demar- Cation, 16 cases with an unclear demarcation, 7 cases with necrosis and cyst formation in central masses, 5 cases with tumor hemorrhage, 1 case with tumor rupture, 8 cases with intra-hepatic metastasis, 7 cases with hilar and retroperitoneal lymph node metastasis, 9 cases with vein thrombosis. CT enhancement scan showed that 2 presented with uneven en- hancement, 12 with patchy and spot-like enhancement, 9 with ring enhancement or alignment enhancement in edge of tumor lesions of these 23 cases of invasive growth tumors. Conclusion CT signs can reflect the malignancy of massive type of primary hepalocellular carcinoma. The tumor with an expansive growth manner possesses lower malignant degree and good prognosis, conversely. The tumor with an invasive growth manner has higher malignant degree and poor progno-sis.