胆管囊腺癌..pptVIP

Case discussion 2012-8 Xiao-dong Zhang history Female,64 years old 2012-5-24：突发右上腹痛7小时入院（腹痛数月） 右上腹压痛 Murph’s sign (-) 无恶心呕吐 低热37° 2012-6-5：肝四段切除术 三期强化 reformat CT value 其他 analysis Key signs（位置、大小、密度、强化） 可能受累的器官 诊断和鉴别诊断 肝局灶肿物中最可能不是什么：HCC？血管瘤？囊肿？脓肿？转移瘤？胆管癌？ Why？怎么想的，speak loudly 最可能是什么？囊腺癌？神经源性？ Post-surgery CT Additional inf. Tumor markers CEA 48.75 (0-5) CA19-9 more than 1000U/L (0-27) 西青区农民 超声：肝内囊性肿物 pathology 术中：四段巨大囊实性肿物，5×5cm，侵犯胆囊，有部分大网膜包绕，将4段肝与胆囊一并切除。 病理：部分肝肿物切除术后，切面可见囊实性肿物 肝四段高分化浆液性乳头状囊腺癌，切端阴性 慢性胆囊炎 大网膜局部纤维组织增生伴出血，未见转移癌 Final diagnosis Biliary Cystadenocarcinoma DDx predominantly cystic components cystic components：complicated Solitary 囊腺瘤 Biliary Cystadenoma 囊性单发转移瘤 cystic metastases 囊性肝癌 Cystic hepatocellular carcinoma 胆管癌 cholangiocarcinoma Calori病 Caroli Disease 神经鞘瘤 schwannoma 感染性病变：脓肿、包虫病 Abscesses/hydatid cysts 血肿 hematoma Biliary Cystadenoma Biliary cystadenoma is a rare benign cystic neoplasm lined by mucin-secreting epithelium premalignant form of biliary cystadenocarcinoma “ovarian-like” stroma Biliary Cystadenoma multilocular cystic lesions Internal septa and mural nodularity may be identified, there is considerable overlap with the imaging appearances of cystadenocarcinoma mural nodularity Biliary Cystadenoma Biliary Cystadenoma Biliary Cystadenoma Caroli Disease secondary to the failure of or an abnormality of the embryologic remodeling of bile ducts intrahepatic bile ducts dilatation Segmental more often saccular than fusiform Caroli Disease central dot sign represents enhancing fibrovascular bundles along the margin or within the dilated bile ducts enhancement Caroli Disease Caroli Disease Intrahepatic cholangiocarcinoma the second most common primary hepatic tumor three types on the basis of gross morphologic features: mass-forming (the most common) periductal infiltrating intraductal growth Intrahepatic cholangiocarcinoma risk factors : chronic biliary inflammation Intr