肝脏子宫内膜异位症病例：持续存在的诊断难题。
Case hepatic endometriosis: a continuing diagnostic dilemma.
作者信息
Goldsmith P J, Ahmad N, Dasgupta D, Campbell J, Guthrie J A, Lodge J P A
机构信息
Hepatobiliary and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, UK.
出版信息
HPB Surg. 2009;2009:407206. doi: 10.1155/2009/407206. Epub 2009 Jul 5.
BACKGROUND
Intraparenchymal endometriosis of liver is rare. It may present as liver tumour and the diagnosis is not usually established till after surgery.
CASE OUTLINE
A 48-year-old postmenopausal woman presented with right upper quadrant pain and a cystic liver mass. Liver function tests and tumour markers (alphaFP, CEA, CA 19-9, and CA 125) were normal. Radiological imaging (USS, CT and MRI) suggested a thick walled cystic mass involving segments IV and VIII with complex intracystic septations. Frozen section at operation suggested a benign cystadenoma. The cyst was enucleated using a CUSA (Cavitron ultrasonic aspirator). The final histology confirmed endometriosis.
DISCUSSION
Eleven cases of hepatic endometrioma have been reported and only four in postmenopausal women. Preoperative diagnosis poses a challenge and so far none of the cases have been diagnosed preoperatively. Surgery remains the treatment of choice. Accurate diagnosis at time of operation may avoid extensive liver surgery and its associated morbidity.
背景
肝实质内子宫内膜异位症罕见。它可能表现为肝脏肿瘤，通常直到手术后才能确诊。
病例概述
一名48岁绝经后女性出现右上腹疼痛和肝脏囊性肿块。肝功能检查和肿瘤标志物（甲胎蛋白、癌胚抗原、糖类抗原19-9和糖类抗原125）均正常。放射学影像检查（超声、计算机断层扫描和磁共振成像）显示一个厚壁囊性肿块，累及肝段IV和VIII，囊内有复杂分隔。术中冰冻切片提示为良性囊腺瘤。使用超声吸引刀（Cavitron超声吸引器）将囊肿摘除。最终组织学检查确诊为子宫内膜异位症。
讨论
已报道11例肝子宫内膜瘤病例，绝经后女性仅有4例。术前诊断具有挑战性，迄今为止尚无病例在术前得到诊断。手术仍然是首选治疗方法。术中准确诊断可避免广泛的肝脏手术及其相关并发症。
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