肝脏原发性癌肉瘤的临床特点及影像表现(附3例报告并文献复习)

Clinical Features and Imaging Findings of Primary Hepatic Carcinosarcomas

目的探讨肝脏原发性癌肉瘤(PHCS)的临床特点及CT、MRI影像表现特征。方法回顾性分析经病理证实的3例PHCS患者的临床资料、CT及MRI图像及病理结果,结合文献报道总结PHCS的临床及影像特征。结果 1例位于左叶外生性生长,1例位于右叶S6,1例位于右叶S7。3例均为边界清楚的较大肿块,易液化坏死,呈囊实性混杂密度/信号,边缘实性部分呈结节状、乳头状向内突起。1例(肝细胞癌Ⅳ级+纤维肉瘤)实性部分多期增强扫描呈"快进快退"强化;1例(胆管上皮癌Ⅲ级+恶性纤维组织细胞瘤)实性部分呈渐进性强化;1例(高分化肝细胞癌+纤维肉瘤+软骨肉瘤)肿块边缘见小片状致密钙化,实性部分增强扫描亦呈"快进快退"表现。结论PHCS的影像学表现与其癌性成分及肉瘤性成分有关,仔细分析CT、MRI征象,可提高术前诊断正确性,确诊依赖病理及免疫组织化学检查。

Objective To investigate the clinical characteristics and CT,MR imaging findings of primary hepatic carcinosarcomas. Methods The clinical datas,CT,MR images,and the pathological findings of 3 cases of primary hepatic carcinosarcomas were retrospectively analyzed. Combined with the literature review,Clinical characteristics and imaging features were discussed. Results CT and MR images revealed an isolated lage,well-defined and heterogeneous mass with liquefaction and necrosis. The solid component located in the margin presented as nodular and papillary in appearance. The enhancement of the solid component of case no. one（ hepatic cellular carcinoma and fibrosarcoma） faded away,demonstrating ＂fast washing out ＂phenomenon. The enhancement of case no. two（ cholangiocellular carcinoma and malignant fibrous histiocytoma） showed progressive enhancement patern. A peace of dense calcification was seen in the margin in case no.three（ well-differentiated hepatic cellular carcinoma,fibrosarcoma and chondrosarcoma）. The enhancement of the solid compilation of the case also manifested ＂fast washing out ＂. Conclusion The imaging features of the primary hepatic carcinosarcomas depend on the subtypes of the carcinomous and sarcomatous elements. CT and MR imaging may be helpful for the preoperative diagnosis. Pathological and immunohistochemical examinations are essential for the final diagnosis.