肝血管平滑肌脂肪瘤的超声诊断探讨.pdfVIP

谱可检出动脉频谱[6,11] 本例术前超声检查疑为包膜型肝癌 但术后回顾性分析则认为以下几点有助于与 肝癌的鉴别 虽肿块巨大 但边界尚清 形态尚规则 呈类圆形 内部虽回声不均 但无瘤中之瘤的征 象 仅具有片状高回声 可能为脂肪组织 亦无液化坏死区 CDFI检测肿块周边及内部虽有较多的血 流信号 但血管形态尚规则 无迂曲扩张的血管 频谱多普勒检测不具备高阻血流信号 RI为0.54 结 合CT增强扫描 门脉期病灶明显强化 延迟期未见消退 仍较强化 呈低-等不均匀密度 不似肝癌病灶 增强后 快进-快出 表现 有作者认为,超声引导下经皮肝穿刺活检有助于确诊肝AML,但由于绝大多数肿瘤内有发育异常的血管, [12] 穿刺检查可诱发难以控制的大出血 ,故穿刺检查应慎重 肝AML 的确诊有赖于病理检查 除光镜HE染色表现外 免疫组化 HMB-45 阳性 具有较大诊断价值 [5,8]本例免疫组化染色结果:HMB-45 肿瘤中平滑肌样细胞和上皮样细胞呈阳性反应 SMA 肿瘤血管内皮 细胞和部分平滑肌样细胞呈阳性反应 参考文献 1. Lin KJ, Eng HL, Lu SN, et al. Hepatic angiomyolipoma: report of two cases with emphasis on smear cytomorphology and the use of cell block with immunohistochemical stains. Diagn Cytopathol. 2004,31(4):263-266. 2.Hoffman AL, Emre S, Verham RP, et al.Hepatic angiomyolipoma: two case reports of caudate-based lesions and review of the literature. Liver Transpl Surg.1997,3(1):46-53. 3.CarmodyE,YeungE,McLoughlinM.Angiomyolipomas of the liver in tuberous sclerosis. Abdom Imaging.1994,19:537-539. 4.HooperLD,MergoPJ,RosPR.Multiple hepato renal angiomyolipomas: diagnosis with fat suppression, gadolinium-enhanced MRI. Abdom Imaging.1994,19:549-551. 5.Schlingemann RO, Rietveld FJ, Kwaspen F, et al.Differential expression of markers for endothelial cells, pericytes, and basal lamina in the micro vasculature of tumors and granulation tissue. Am J Pathol.1991,138:1335-1347. 6.崔健,周信达,纪元,等. 肝血管平滑肌脂肪瘤的诊断与治疗. 中国实用外科杂志,2000,20(6):364-365. 7.Irie H, Honda H, Kuroiwa T, et al. Hepatic angiomyolipoma: report of changing size and internal composition on follow-up examination in two cases. J Comput Assist Tomogr. 1999,23(2):310-313. 8.DalleI,SciotRc,deVosR,etal.Malignant angiomyolipoma of