肝脏反应性淋巴增生1例报道并文献复习

Reactive Lymphoid Hyperplasia of Liver:A Case Report and Review of The Literatures

目的 探讨肝脏反应性淋巴增生的临床表现、影像学特征及治疗。方法 分析笔者所在医院收治的1例肝脏反应性淋巴增生患者的临床资料和诊治过程，同时对文献报道的49例患者的资料进行分析。结果 共检索出PubMed数据库中的相关文献33篇（49例） 加上本例患者共50例。50例患者中，女45例（90%），男5例（10%）；年龄15～85岁、（57.6±14.0） 岁。8例（16%）为多发肿瘤，42例（84%）为单发肿瘤；6例因腹痛或腹部不适就诊发现（12%），2例（4%）于手术中发现，2例（4%）于肝移植术后病理学检查时发现，1例（2%）于尸检时发现，余39例（78%）患者于体检或复查中发现；25例（50%）位于右肝，15例（30%）位于左肝，4例（8%）为左右肝多发，1例（2%）位于尾状叶，另有5例（10%）文献未明确说明。术前有恶性肿瘤史11例（22%），合并自身免疫性疾病15例（30%），合并病毒性肝炎感染5例（10%）。术前诊断为恶性肿瘤36例（72%）。43例（86%）行手术切除治疗。结论 肝脏反应性淋巴增生是一种罕见的疾病，好发于中年女性，患者常患有自身免疫性疾病及恶性肿瘤。手术切除可能是其唯一有效的治疗方法。

Objective To study the clinical manifestation, radiographic characteristics, and treatments of reactive lymphoid hyperplasia （RLH） of liver.Methods The clinical data and treatment process of 1 patient with RLH of liver in our hospital was analyzed retrospectively, and the other 49 cases reported in English literature were reviewed. Results There were 33 pieces of case reports found in PubMed database. For all 50 patients, there were 45 female （90%） and 5 male （10%） patients, and the mean age was （57.6±14.0） years （15-85 years）. Only 8 patients （16%） were discovered with multiple mass, the rest of them were solitary mass （84%）. Of the 50 patients, 6 patients （12%） were discovered because of bellyache, 2 patients （4%） were discovered during operation, 2 patients （4%） were discovered by pathological examination after liver transplantation, 1 patient （2%） was discovered during autopsy, 39 patients were discovered during examination or reexamination. The tumors were located in the right lobe for 25 patients （50%）, in the left lobe for 15 patients （30%）, in the both lobes for 4 patients （8%）, and in the caudal lobe for 1 patient （2%）, while 5 cases （10%） were not given in the articles. Eleven patients （22%） had the history of malignancy, 15 patients （30%） were concomitant with autoimmune disease, and 5 patients （10%） were concomitant with virus hepatitis infection. Thirty-six patients （72%） were diagnosed as malignancy preoperatively, and 43 patients （86%） underwent surgical resection. Conclusions RLH of liver is an extremely rare and benign condition which presents a female predilection and often concomitants with autoimmune disease and history of malignancy. Considering the risk of malignant transformation, surgical resection is recommended and further researches are necessary for better understanding of this disease.