原发性肝脏神经内分泌癌CT表现(附4例报道及文献复习)

CT features of primary hepatic neuroendocrine carcinoma

目的:分析原发性肝脏神经内分泌癌(PHNEC)的CT表现及其临床特点,旨在提高对该肿瘤的影像诊断水平。方法:回顾性分析4例经病理证实为PHNEC患者的影像学资料,并检索近10年来有关肝脏原发神经内分泌癌的文献,对该病的影像学表现及临床特点进行总结分析。结果:本组4例均行CT检查,单发1例,多发3例,肿瘤最大径4.1~16.1cm。CT平扫表现为肝内低密度占位性病变,囊变坏死明显,边界较清楚,增强扫描后实性部分可呈持续性强化,也可表现为"快进快出"。血清学检查中甲胎蛋白(AFP)、癌胚抗原(CEA)、CA-199绝大多数为阴性,而神经元特异性烯醇化酶(NSE)多呈阳性。结论:PHNEC是一种罕见的肝脏原发肿瘤,最终诊断虽需病理证实,但PHNEC的CT及血清学表现具有一定的特征性,CT检查结合血清学指标检测可提高该病的诊断正确率,从而指导临床进行下一步治疗。

Objective： To analyze the CT findings and clinical features of primary hepatic neuroendocrine carcinoma（PHNEC） in order to improve the diagnostic level of the tumor.Methods： The imaging data of 4 patients with PHNEC confirmed by pathology were retrospectively analyzed,and the literatures about the primary neuroendocrine carcinoma of the liver in the past 10 years were retrieved.The imaging manifestations and clinical features of the disease were analyzed.Results： In this group,four cases underwent CT scan examination,and CT scan showed one case was solitary,and three cases was multiple.The maximum diameter of the tumor was 4.1 - 16.1cm.On plain CT,lesions were hypodense with obvious cystic and necrosis,and clear border.The contrast-enhanced CT showed persistent enhancement but without any enhancement in necrotic area.AFP,CEA and CA-199 were negatively expressed in most patients,while NSE was positively expressed.Conclusion： PHNEC is an extremely rare primary liver tumor.Pathology is mandatory to confirm the diagnosis,but PHNEC has certain imaging characteristics and serological performances.Therefore,we can improve the diagnostic accuracy of the disease,so as to guide the clinical treatment of the next step.