肝局灶性结节性增生的临床病理学研究

A clinicopathological study of hepatic focal nodular hyperplasia

目的 探讨肝局灶性结节性增生的病理形态学特点。方法 分析 2 5例肝局灶性结节性增生患者的临床资料 ,采用HE染色并结合组织化学PAS、Masson三色网状纤维染色及免疫组织化学EnVisionTM法观察该病的形态特点 ,并观察 2例的超微结构特征。结果 2 5例肝局灶性结节性增生 ,男性 17例 ,女性 8例 ,年龄 14～ 5 8岁 ,平均 38岁。均发生于甲胎蛋白阴性的中青年人 ,2 2例无肝炎背景。组织学上 16例有特征性的中央纤维瘢痕 ,由纤维结缔组织和扭曲的血管组成 ,并向外放射状形成许多纤维间隔。纤维间隔围绕无明显异形的肝细胞形成硬化样结节。结节周边肝细胞与纤维间隔内增生的胆小管细胞相移行 ,这些肝细胞与增生的胆小管细胞角蛋白的表达情况相似。电镜下瘤细胞与正常肝细胞相似。 2 0例随访 6～ 47个月 ,均无瘤生存。

Objective To study the clinicopathological features of focal nodular hyperplasia (FNH). Methods The clinicopathological characteristics of 25 cases of FNH were studied retrospectively. 20 cases followed for 6 to 47 months. All were evaluated by use of paraffin embedded sections, special and immunohistochemical staining (EnVision TM method) and electron microscope. Results 17 female and 8 male FNH patients aged 14 to 58 (median 38) years of age, all alpha fetoprotein negative, asymptomatic and normal biochemical liver tests in most cases. The macroscopic hallmark is a central stellate fibrotic scar, composed of fibrous connective tissue and tortuous blood vessels, the fibrous tissue radiated peripherally , dividing the mass into multiple, variably sized nodules, simulating the pattern of cirrhosis. Microscopically, multinodular proliferation of benign appearing hepatocytes separated by bile duct containing fibrous septae that radiate from the central scar. Internodular bile duct proliferation is abundant and merge imperceptibly with the hepatocyte elements near the fibrous septa. Immunohistochemically, the keratin expessed by hepatocytes and by the proliferated bile ducts were similar. Electron microscopic examination found that the ultrastructure of tumor cells were similar to normal hepatocytes. 20 cases were followed for 6 47 months, all survived with no recurrence. Conclusion FNH is a benign hepatocytic lesion, i.e. a reactive proliferation of hepatic cells to local blood vessel anomalies.