原发性肝血管肉瘤的病理与影像学对照

Pathology and imaging of primary hepatic angiosarcoma

目的观察原发性肝血管肉瘤的CT、MRI表现,与病理对照,分析其病理学基础。方法回顾性分析经病理证实的5例原发性肝血管肉瘤患者的CT、MRI表现,评价病灶的部位、大小、形态、密度(信号)特点、强化方式,并与病理对照观察。结果 5例病人中4例单发,1例多发。单发病例病灶类圆形或分叶状,CT平扫低密度,内密度不均,增强扫描渐进性强化,但至平衡期仍不能完全填充;1例MRI示T1WI低信号,T2WI高信号,信号不均,DWI高信号,增强扫描渐进性强化,延时仍不能完全填充。病理示病灶内可见出血、坏死及纤维化。结论原发性肝血管肉瘤的影像学表现有一定特征性,常表现为单发或多发肿块,易出血坏死,呈渐进性强化,延时期不能完全填充,可提示诊断,但特异性低,仍需病理检查方能确诊。

Objective To observe the CT, MRI findings of primary hepatic angiosarcoma （PHA） and analyze its pathological basis. Methods CT images （5 cases） and MR images （1 case） of PHA patients confirmed by histopathology were retrospectively analyzed. The location, size, form, density（signal）and enhancement pattern were evaluated. These findings were explored with histopathology findings. Results In 5 pateints, there were 4 of signle mass type, 1 of multiple mass. The dominant mass demonstrated lobular or round in shape. CT scan showed PHA in low density, within the uneven density. Enhanced scan was progressively strengthened, but it could not be completely filled on the equilibrium phase. One case showed heterogeneous hypointensity at TIWI, markedly hyperintersity at T2WI and DWI. It was not completely filled on equilibrium phase while enhancement were strengthened progressively. The pathological lesions showed hemorrhage, necrosis and fibrosis. Conclusion Imaging features of PHA have certain characteristics. PHA often show single or multiple mass with internal hemorrhage, necrosis, progressive enhancement. It can not be completely filled in delay period. These signs suggest the diagnosis with low specificity. Pathological examination is imprtant to confirm the diagnosis.