胃外肝样腺癌的影像学诊断

Imaging findings of extragastric hepatoid adenocarcinoma

目的:总结分析9例胃外肝样腺癌的影像学表现,提高对胃外肝样腺癌的认识。方法:搜集9例经病理确诊为胃外肝样腺癌患者的临床及影像资料,分析其性别、年龄、肝炎病史、治疗前血清甲胎蛋白(AFP)、免疫组化AFP、病灶部位、形态、大小、强化程度及方式、淋巴结转移、邻近器官侵犯、远处转移等情况,总结其临床及影像学特征。结果:9例患者中男6例,女3例,发病年龄32~69岁,平均(56.2±14.1)岁,均无肝炎病史。7例治疗前血清AFP升高,免疫组化AFP 7例阳性表达。发病部位分别为肺3例、胆囊2例、胰腺1例、小肠1例、结肠1例、腹腔1例。除1例小肠肝样腺癌表现为肠壁增厚外,其余8例均表现为大小不等的类圆形或不规则形肿块。9例胃外肝样腺癌均呈不均匀强化,5例行CT多期增强扫描者表现为动脉期中度强化,静脉期4例延迟强化、1例强化轻度减弱;2例未行CT多期增强扫描者表现为中度强化;2例行MRI检查者表现为中度延迟强化。3例肺肝样腺癌均有纵隔淋巴结转移,2例有肺门淋巴结转移。1例小肠及1例结肠肝样腺癌有肠旁淋巴结及肝脏多发转移。1例腹腔肝样腺癌有腹腔及肠系膜转移。8例行手术治疗,1例行化疗治疗。结论:胃外肝样腺癌罕见,中老年男性好发,临床上血清AFP升高为其特点,增强扫描常呈不均匀强化的肿块,动脉期中度强化及延迟强化有一定特征性,常有淋巴结转移及远处转移。

Objective:To improve the understanding of extragastric hepatoid adenocarcinoma by retrospective analysis of imaging findings of 9 cases.Methods:The clinical and imaging data of 9 patients with pathologically confirmed hepatoid adenocarcinoma after operation or biopsy were collected.The patients'gender,age,history of hepatitis,serum alpha fetoprotein(AFP)before treatment,immunohistochemical AFP,lesion location,shape,size,degree and method of enhancement,lymph node metastasis,adjacent organ invasion and distant metastasis were analyzed.The clinical and imaging features were summarized.Results:Among the 9 patients,there were 6 males and 3 females.The age of disease onset was 32~69 years old,with an average age of(56.2±14.1)years old without history of hepatitis.Serum AFP was increased in 7 cases before treatment,and AFP was positive in 7 cases by immunohistochemistry.The lesions were located in 3 cases of lung(2 cases of right lung and 1 case of left lung),2 cases of gallbladder(1 case of bottom and 1 case of body),1 case of pancreas,1 case of small intestine,1 case of colon and 1 case of abdominal cavity.Except for 1 case of hepatoid adenocarcinoma of small intestine,the other 8 cases were round or irregular masses of different sizes.All the 9 cases of extragastric hepatoid adenocarcinoma showed heterogeneous enhancement with necrosis.5 cases with multi-phase CT enhancement showed moderate enhancement in arterial phase,including 1 case with mild reduced enhancement and 4 cases with delayed enhancement in venous phase;2 cases without multi-phase enhancement showed moderate enhancement;2 cases on MRI showed moderate delayed enhancement.Mediastinal lymph node metastasis was found in 3 cases of pulmonary hepatoid adenocarcinoma,and hilar lymph node metastasis was found in 2 cases.One case of hepatoid adenocarcinoma of small intestine and one case of colon had multiple metastases of periintestinal lymph nodes and liver.One case of abdominal hepatoid adenocarcinoma had abdominal and mesenteric metastasis.Eight patients were treated with surgery and one with chemotherapy.Conclusion:Extragastric hepatoid adenocarcinoma was rare,and it is more common in middle-aged and elderly men.It was clinically characterized by elevated serum AFP.After enhancement it often present a mass with uneven enhancement.It was characterized by moderate enhancement in arterial phase and delayed enhancement.It often had lymph node and distant metastasis.