CT对儿童原发肝脏卵黄囊瘤和肝母细胞瘤的鉴别诊断

The CT imaging features of primary hepatic yolk sac tumor in children differentiated from hepatoblastoma

目的探讨儿童原发肝脏卵黄囊瘤的影像学表现,并寻找可能与肝母细胞瘤相鉴别的影像学特征。方法回顾性分析北京大学第一医院收治的1例原发肝脏卵黄囊瘤患儿的临床表现,尤其是其影像学资料,与22例肝母细胞瘤资料进行对比分析,并复习相关文献。结果原发肝脏卵黄囊瘤患儿为1岁11个月男童,甲胎蛋白(AFP)明显升高,腹部增强CT及B超均提示肝脏右叶巨大单发占位,未见明显钙化,肿物内可见出血、坏死,有包膜下积液等肿瘤破裂迹象。肝母细胞瘤患儿AFP亦明显升高,腹部增强CT提示多为单发肝脏巨大肿物,结节状多见,无包膜,多见点状或片状钙化,肿物周边有明显血流信号,未见有肿瘤破裂迹象。复习文献8例原发肝脏卵黄囊瘤患儿的影像学资料显示多有出血和坏死表现,1例有明显肿瘤破裂表现,无钙化。结论原发肝脏卵黄囊瘤和肝母细胞瘤都表现为肝脏巨大占位伴AFP明显升高,前者影像学特征是肿物更容易出现出血、坏死和肿瘤破裂迹象,有包膜,无钙化,对二者有一定的临床鉴别价值。

Objective To investigate the imaging of primary hepatic yolk sac tumor in children and to find the imaging features that may be differentiated from hepatoblastoma.Methods The clinical manifestations and the imaging data of one patient with primary hepatic yolk sac tumor admitted to Peking University First Hospital were retrospectively analyzed,the clinical data of 22 patients with hepatoblastoma were compared,and literatures were reviewed.Results The patient was a boy of 1 year and 11 months old.The alpha-fetoprotein(AFP)was significantly elevated.The abdominal enhanced CT and ultrasound showed huge single mass in the right lobe of the liver.Hemorrhage,necrosis and subcapsular effusion were seen in the mass,but without obvious calcification.AFP was also significantly increased in children with hepatoblastoma.Abdominal contrast-enhanced CT showed that most of them were single giant liver masses,nodular,without capsule,punctured or lamellar calcification,with obvious blood flow signals around the masses,and no signs of tumor rupture.The imaging findings of 8 children with primary hepatic yolk sac tumor were reviewed,and most of them showed bleeding and necrosis.One patient had obvious tumor rupture without calcification.Conclusions Both primary hepatic yolk sac tumor and hepatoblastoma present with huge hepatic mass with significantly elevated AFP.The imaging features of yolk sac tumor are more likely to show signs of hemorrhage,necrosis and tumor rupture.