肝脏炎性假瘤样滤泡树突状细胞肿瘤1例临床分析

Inflammatory pseudotumor-like follicular dendritic cell tumor in liver:A case report

炎性假瘤样滤泡树突状细胞肿瘤是滤泡树突状细胞肿瘤的一个亚型,在临床上非常罕见。其病变常见于肝、脾等腹腔脏器,并常伴随淋巴细胞等炎性细胞浸润,易出现误诊。本文报道肝脏炎性假瘤样滤泡树突状细胞肿瘤1例。57岁女性患者,以无痛性腹部包块为首发症状,并伴消瘦、纳差等症状。3个月后在当地医院行上腹部MR提示:肝左叶占位性病变,考虑恶性肿瘤可能。2016年9月行左半肝切除手术。术后1年余复查CT提示肝右叶占位性病变,考虑肝内转移可能。2018年3月在广州中医药大学第一附属医院住院,血分析、肝功能、相关肿瘤抗原检测等检查均未发现明显异常。乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)、乙肝核心抗体(anti-HBc)等检测均为阴性。2018年3月23日排除相关手术禁忌症后在广州中医药大学第一附属医院行肝右叶肿物切除手术,术后病理显示肿瘤由增生的类圆形或梭型细胞构成,间质见淋巴细胞、浆细胞等浸润,瘤细胞胞浆红,核淡染,见小核仁。免疫组织化学:CD21(±)、CD138(-)、CD3(-)、CD20(-)、SMA(-)、CD34(-)、CK(-)、Ki-67(±);EBV-encoded RNA(EBER)原位杂交:EBER(+)。病理确诊(肝)炎性假瘤样滤泡树突状细胞肿瘤。术后予预防感染、增强免疫力、护肝等治疗后出院,观察1月余未出现二次复发或转移。

Inflammatory pseudotumor-like follicular dendritic cell tumor（IPT-like FDCT）,rare in clinic, is an unique subtype of follicular dendritic cell tumor（FDCT）.IPT-like FDCT often occurs in abdominal viscera, mostly in the liver or spleen. Pathologically and histologically, infiltration of inflammatory cells, lymphocyte cells in mainly, can be found as the character. Its easily to make an mistake in clinical diagnosis. We report one case of IPT-like FDCT in liver to study. The patient, female, 57-year-old,was suffered from abdominal mass with no pain, which was considered as the first symptom. And the symptoms of weight loss and eating less were observed at the same time. Three months later, the patient had an upper abdomen magnetic resonance（MR） at the local hospital. The MR reported： a space-occupying disease in left hepatic lobe was found, and malignant tumor was considered. In September 2016, the patient was treated by surgery of left half liver excision operation. More than a year later, she had upper abdomen computed tomography（CT）, and hepatic right lobe occupying lesion was reported. It prompted the possibility of intrahepatic metastasis. The patient gone to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine（TCM）, and the laboratory examinations manifested negative, including blood analysis, liver function examination, tumor associated antigen detection, et al. The examinations of hepatitis B all manifested negative, containing hepatitis B surface antigen（HBsAg）, hepatitis B e antigen（HBeAg）, hepatitis B core antibody, et al.As the treatment, the right hepatic lobe mass excision operation was finished in March 23, 2018, atthe First Affiliated Hospital of Guangzhou University of TCM. The pathological examination reported that the tumor was composed of hyperplasia quasi-circular or spindle cell, infiltration of lymphocytes, plasma cells in intercellular substance, and tumor cells with red cytoplasm, light-color small nucleus. Immunohistochemistry：CD21（±）,CD138（-）,CD3（-）,CD20（-）,SMA（-）,CD34（-）,CK（-）,Ki-67（±）; EBV-encoded RNA（EBER） in situ hybridization： EBER（＋）. According to examination of pathology, a diagnosis of IPT-like FDCT in liver was determined. After the second surgery, the patient recovered from hospital by symptomatic treatment, such as to prevent infection, enhance immunity, protect function of liver, et al. And its no recurrence or metastasis from observation in one month.