肝内胆管腺瘤的超声声像图及临床病理学特征分析

Analysis of ultrasonographic and pathological features of intrahepatic bile duct adenoma

目的:探讨肝内胆管腺瘤(intrahepatic bile duct adenoma,BDA)的超声声像图表现及临床病理学特征。方法:收集2019年1月—2021年7月复旦大学附属中山医院及复旦大学附属中山医院厦门医院经穿刺活检及手术后病理学检查诊断为BDA的患者6例,结合临床及病理学表现分析其常规超声和超声造影特点。结果:6例患者共9个病灶,所有病灶均位于肝脏包膜下。病灶最大为12 mm×10 mm,最小为6 mm×5 mm。9个病灶中有3个肿块中央出现高回声,周围是低回声环,类似“靶环征”,与病理学表现具有一定的相关性。3个肿块边界清晰,6个病灶边界欠清或边界不清。彩色多普勒超声均未见明显彩色血流。超声造影显示6个病灶快速整体增强,3个病灶同步增强。9个病灶动脉期晚期或门脉期减退,均呈“快进快出”类型。超声诊断良性病变3个,恶性病变6个,准确度为33.3%。病理学上可见大量增生的小胆管,伴广泛慢性炎细胞浸润,胆管上皮分化良好,随着病程的进展,病变内增生的胆管和浸润的炎性细胞逐渐减少,纤维组织逐渐增多。结论:BDA的超声图像及临床病理学表现具有一定的特征,掌握其特点有利于增加对BDA的认识,提高其诊断准确率。

Objective:To investigate the ultrasonography and clinicopathology features of intrahepatic bile duct adenoma(BDA).Methods:Six patients with BDA diagnosed by biopsy and surgery pathology in Zhongshan Hospital and Xiamen Branch,Fudan University from January 2019 to July 2021 were analyzed for the characteristics of conventional ultrasound and contrast-enhanced ultrasound(CEUS),and their characteristics were summarized in combination with the clinical and pathological manifestations.Results:There were 9 lesions in 6 patients,all of which were located under the liver capsule.The maximum lesion size was 12 mm×10 mm and the minimum lesion size was 6 mm×5 mm.In 2 of the 9 lesions,hyper echo appeared in the center,surrounded by low echo ring,similar to the target ring sign,which had a certain correlation with pathology.Three lesions were clearly demarcated,and six lesions were poorly or ill-demarcated.There was no obvious color blood flow in Doppler ultrasound.CEUS showed rapid overall enhancement in six lesions and synchronous enhancement in three lesions.All of the 9 lesions showed rapid entry and rapid exit in the late arterial or portal phase.Three benign lesions and six malignant lesions were diagnosed by ultrasonography,and the accuracy was 33.3%.Pathologically,a large number of proliferative bile ducts can be seen in this disease,accompanied by extensive chronic inflammatory cell infiltration,and the bile duct epithelium is well differentiated.With the progress of the disease,the proliferative bile ducts and infiltrating inflammatory cells in the lesion gradually decrease,while the fibrous tissue gradually increases.Conclusion:Ultrasonography and clinicopathology of BDA have certain characteristics,and it is helpful to understand BDA and improve the diagnostic accuracy.