Kim Soo Ryang, Kim Ke Ih, Maekawa Yoko, Imoto Susumu, Ninomiya Toshiaki, Mita Keiji, Ando Kenji, Fukuda Katsumi, Fuki Syuichi, Kudo Masatoshi, Matsuoka Toshiyuki, Sasase Noriko, Taniguchi Miyuki, Hayashi Yoshitake
Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1559-62.
A rare case of well-differentiated minute hepatocellular carcinoma (HCC) with hepatitis C virus-related cirrhosis, with unusual radiologic features, is presented. A 10-mm hypoechoic nodule disclosed by ultrasound in segment six showed hypoattenuation on computed tomography hepatic arteriography and hyperattenuation on computed tomography during arterial portography, indicating that the portal vein may have been the dominant vascularity of the nodule. Contrast-enhanced ultrasound revealed hypovascularity in the early arterial phase, isovascularity in the late vascular phase, and the same perfusion as that surrounding the liver parenchyma in the post-vascular phase, with the same pattern observed on the two imaging techniques. These findings were considered not compatible with those of well-differentiated HCC. Ultrasound-guided biopsy showed histological features of well-differentiated HCC with over two-fold the cellularity of the non-tumorous area with a high nuclear/cytoplasmic ratio, increased cytoplasmic eosinophilia, slight atypia and fatty change with an irregular thin trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.
本文报告一例罕见的伴有丙型肝炎病毒相关性肝硬化的高分化微小肝细胞癌（HCC），其具有不寻常的放射学特征。超声检查发现肝VI段有一个10毫米的低回声结节，在肝动脉造影计算机断层扫描上呈低密度，在动脉门静脉造影计算机断层扫描上呈高密度，提示门静脉可能是该结节的主要血供来源。超声造影显示在动脉早期为低血供，在血管晚期为等血供，在血管后期与肝实质周围灌注相同，两种成像技术观察到相同的模式。这些表现被认为与高分化HCC不符。超声引导下活检显示为高分化HCC的组织学特征，细胞密度是非肿瘤区域的两倍多，核/质比高，胞质嗜酸性增加，轻度异型性和脂肪变，呈不规则细小梁状。进一步的研究可能会深入了解多步骤肝癌发生过程中肿瘤新生血管与包括动脉和门静脉在内的双重血流动力学之间的相关性。
