肝腺瘤与局灶性结节增生诊治体会——附10例报告与文献复习

Hepatocellular adenoma and focal nodular hyperplasia:report of 10 cases and literature review

目的探讨肝腺瘤与局灶性结节增生的临床表现与影像学特征,深化对这两种良性肝脏占位的认识。方法收集解放军401医院2010年1月至2015年12月期间,经病理证实的肝腺瘤和局灶性结节增生病例,总结临床资料,进行回顾性分析并复习相关文献。结果共收集3例肝腺瘤和7例局灶性结节增生病例,均因查体时发现肝脏占位入院,肿瘤标志物和肝功能等常规化验检查均正常。两种疾病的典型增强影像特点分别是,肝腺瘤在动脉期呈不均匀快速强化,强化的强度弱于局灶性结节增生。在门脉期和平衡期,肝腺瘤呈低信号表现。局灶性结节增生在动脉期均匀快速强化,在门脉期和平衡期,呈等信号或者稍高信号。局灶性结节增生的中央瘢痕有鉴别诊断价值。结论肝腺瘤和局灶性结节增生在鉴别诊断方面的相关研究较少,熟悉其影像学特征有助于正确诊断,避免误诊误治。

Objective To explore the clinical features and imaging characteristics of hepatocellular adenoma（HCA） and focal nodular hyperplasia（FNH） and deepen the understanding for the both benign hepatic lesions. Methods The clinical data of HCA and FNH patients were collected between January 2010 and December 2015. The diagnosis of every patient was confirmed by pathology. The retrospective analysis and literature review were done. Results Three patients with HCA and 7 patients with FNH were included into the study. They were admitted to hospital for hepatic lesion which was found in physical examination. Tumor markers including CA19-9, AFP and CEA, and other routine laboratory tests were normal. Typical imaging features of enhanced CT/MRI were shown as follows： rapid heterogeneous enhancement of HCA was seen in the arterial phase. Compared with FNH, the arterial enhancement of HCA was relatively weak. During portal venous and equilibrium phases, HCA appeared hypointense. In contrast, FNH enhanced more homogeneously and arterial enhancement was stronger than in HCA. In the portal venous and equilibrium phases, FNH appeared iso-or slightly hyperdense. A central scar was of value for differential diagnosis. Conclusion There is limited evidence of the diagnostic performance of imaging modalities for the differentiation of HCA and FNH. Imaging characteristics of HCA and FNH should be understood well in order to increase accuracy of diagnosis and avoiding misdiagnosis and unnecessary treatment.