原发性透明细胞型肝癌的影像表现及比较分析研究

Imaging Features of Primary Clear Carcinoma of Liver and Comparative Analysis Study

目的探讨原发性透明细胞型肝癌(PCCCL)的CT、MRI表现,并与普通类型肝细胞癌(CHCC)及硬化型肝细胞癌(SHCC)进行对比分析。方法回顾性分析38例经病理证实的PCCCL的影像表现,并依据临床实验室检查及影像表现分别与250例CHCC及53例SHCC进行比较。采用χ~2检验、Fisher确切概率法、t检验或秩和检验分析其差异。结果 PCCCL多位于肝脏边缘部位,无邻近肝包膜皱缩。在CT和MRI平扫无特异表现,肿瘤内可见出血、坏死。12例可见脂肪变(31.6%),其与肿瘤大小无明显相关性。21例可见假包膜形成(55.3%)。多期增强扫描以CHCC经典的强化方式为主(92.1%)。不同透明细胞含量PCCCL在年龄、性别、肝炎及肝硬化背景、肿瘤大小、含脂肪病变、生长部位及甲胎蛋白(AFP)值组间比较均无明显差异(P>0.05),而当透明细胞含量>70%时,肿瘤假包膜形成的概率更高、分化程度更高(P<0.05)。与CHCC相比,PCCCL患者病毒性肝炎背景概率相对较低,血管受侵概率更小,AFP值正常的概率更大,且肿瘤多分布于肝脏边缘部位,多见脂肪变(P<0.05);在年龄、性别、肝硬化背景、肿瘤大小及淋巴结转移上无明显差异(P> 0.05)。与SHCC相比,PCCCL患者年龄更大,肿瘤体积更小,多见脂肪变,AFP值正常的概率更大(P<0.05);在性别、病毒性肝炎及肝硬化背景、生长部位、血管受侵及淋巴结转移上无明显差异(P> 0.05)。结论 PCCCL是原发性肝细胞癌少见的细胞学亚型,其在影像及临床实验室检查上与CHCC及SHCC既有重合,又有其自身特点。

Objective To investigate CT and MRI findings of primary clear-cell carcinoma of liver(PCCCL)and the difference from common type hepatocellular carcinoma(CHCC)and scirrhous hepatocellular carcinoma(SHCC).Methods The CT and MRI features of thirty-eight patients with PCCCL proved by pathologic examination were retrospectively reviewed.The clinical laboratory examination and imaging features were compared with 250 cases of CHCC and 53 cases of SHCC respectively,which were analyzed by Chi-square test,Fisher exact probabilities,t-test and Mann-Whitney U test.Results Most PCCCL were observed in edge of the liver without capsular retraction.There were no specific imaging features on pre-contrast CT and MRI scan.Necrosis and hemorrhage were shown inside the tumor.The fatty changes were found in 12 cases(31.6%,12/38)and had no correlation with tumor size.Among them,pseudo-capsules were formatted in 21 cases(55.3%,21/38).The main imaging pattern of multi-phase contrast enhancement were characterized on typical HCC enhancement patterns(92.1%,35/38).There were no statistical differences between the proportion of clear cells regarding age,gender,ratio of patients with viral hepatitis and liver cirrhosis,tumor size and AFP value(P>0.05).While the proportion of clear cells was>70%,tumor were prone to a higher ratio of pseudo-capsule formation and better differentiation(P<0.05).Compared to CHCC,the incidence of patients with PCCCL was at lower ratio in viral hepatitis and vascular invasion,and with higher probability in normal level of AFP value.The tumors were prone to a higher ratio of fatty changes and often located close to the edge of liver(P<0.05).But there was no difference in age,gender,liver cirrhosis,tumor size and lymph node metastases(P>0.05).Compared with SHCC,the patients with PCCCL had an older age,much smaller tumor size and with higher probability in normal AFP values,and the tumors were prone to a higher ratio of fatty changes(P<0.05)and furthermore no significant difference in sex,ratio of patients with viral hepatitis and liver cirrhosis,tumor location,vascular invasion and lymph node metastases(P>0.05).Conclusion PCCCL was an unusual cytology subtype of primary hepatic carcinoma.PCCCL had its own characteristics even if there are some similar features with CHCC and SHCC in imaging and clinical laboratory examination.