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单叶肝胆纤维多囊病。

Monolobar hepatobiliary fibropolycystic disease.

机构信息

Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shizuoka 424-8636, Japan.

出版信息

Pathol Oncol Res. 2011 Mar;17(1):159-65. doi: 10.1007/s12253-010-9285-3. Epub 2010 May 30.

Abstract

We herein report a case of monolobar hepatobiliary fibropolycystic disease. A 75-year-old woman presented with heartburn. Imaging modalities including US, CT, and MRI revealed marked atrophy and multiple biliary cysts of the hepatic left lobe. The hepatic right lobe was normal. ERCP and bile duct endoscopy revealed anomalous pancreaticobiliary union, choledochal dilation, dilation of left intrahepatic bile ducts, and small choledochal non-invasive adenocarcinoma. Polycystic kidney diseases were absent. The patient underwent pancreatico-duodenectomy and extended hepatic left lobectomy. Grossly, the hepatic left lobe was markedly atrophic, and studded with numerous biliary cysts. The left intrahepatic bile ducts were dilated (Caroli's disease) and the common bile duct showed type I choledochal dilation. The right hepatic lobe was normal. Histologically, the hepatic left lobe was replaced by fibroelastosis. The intrahepatic bile ducts showed ductal plate malformation such as irregular contours, invaginations, and protrusions. The numerous biliary cysts also showed ductal plate malformation. There were numerous persistent ductal plates and microhamartomas. Many hyalinized destructive biliary cysts and ductal plates were recognized. The liver parenchyma was scant and free of hepatocellular malformations. The portal veins showed old obliterative portal thrombosis. The right hepatic lobe was normal. Immunohistochemically, the biliary cells were positive for cytokeratin 7, 8, 18 and 19, and MUC6 and CD10, but negative for MUC2 and MUC5AC. The biliary cysts, persistent ductal plate, and microhamartomas were positive for fetal apomucin antigen MUC1.

摘要

我们在此报告一例单叶肝胆纤维多囊病。一名 75 岁女性因烧心就诊。超声、CT 和 MRI 等影像学检查显示肝左叶明显萎缩和多个胆管囊肿。肝右叶正常。ERCP 和胆管内镜检查显示异常胰胆管汇合、胆总管扩张、左肝内胆管扩张和小的胆总管无侵袭性腺癌。多囊肾病不存在。患者接受胰十二指肠切除术和左肝叶扩大切除术。大体上,肝左叶明显萎缩,布满多个胆管囊肿。左肝内胆管扩张(Caroli 病),胆总管呈 I 型扩张。右肝叶正常。组织学上,肝左叶被纤维弹性组织化生取代。肝内胆管呈导管板畸形,如轮廓不规则、内陷和突出。许多胆管囊肿也显示导管板畸形。有许多持续的胆管板和微错构瘤。许多玻璃样破坏性胆管囊肿和胆管板被识别。肝实质稀少,无肝细胞畸形。门静脉显示陈旧性闭塞性门静脉血栓形成。右肝叶正常。免疫组化染色显示,胆管细胞 CK7、8、18 和 19、MUC6 和 CD10 阳性,MUC2 和 MUC5AC 阴性。胆管囊肿、持续的胆管板和微错构瘤对胎儿分泌型粘蛋白抗原 MUC1 呈阳性。

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