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非肝硬化肝脏中的原发性恶性肿瘤。

Primary malignant tumours in the non-cirrhotic liver.

机构信息

Department of Radiology, Seoul National University Hospital, Republic of Korea; Seoul National University College of Medicine, Republic of Korea.

Department of Radiology, Seoul National University Hospital, Republic of Korea; Seoul National University College of Medicine, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Republic of Korea.

出版信息

Eur J Radiol. 2017 Oct;95:349-361. doi: 10.1016/j.ejrad.2017.08.030. Epub 2017 Aug 31.

Abstract

Intrahepatic chlangiocarcinomas (CCs), the second most common primary malignant liver tumours, usually occur in non-cirrhotic liver, and can be classified into three types based on gross morphology: mass-forming; periductal infiltrating; and intraductal growing. Among them, mass-forming intrahepatic CCs are the most common type and characterized by homogeneous mass with an irregular but well-defined margin with peripheral enhancement on late arterial phase and delayed enhancement in central portion of tumours corresponding to the fibrous stroma. Several imaging features such as enhancement pattern and degree of diffusion restriction have been suggested as prognostic markers for mass-forming CCs. Hepatocellular carcinomas (HCCs) are the most common primary malignant liver tumors, and usually arise from the cirrhotic liver. However, approximately 20% of HCCs involve the non-cirrhotic liver (hereafter, non-cirrhotic HCC), and non-cirrhotic HCCs are often detected at an advanced stage due to the lack of surveillance for patients with non-cirrhotic liver. Other primary malignant liver tumours other than CCs and HCCs including angiosarcoma, undifferentiated embryonal sarcoma are quite rare, and imaging diagnosis is often difficult. This review offers a brief overview of epidemiology, risk factors and imaging features of primary malignant tumours in non-cirrhotic liver. Understanding of radiologic appearance and predisposing clinical features as well as differentials of primary malignant tumour in non-cirrhotic liver can be helpful for radiologists to adequately assess these tumours, and subsequently to make optimal management plan.

摘要

肝内胆管细胞癌(CC)是第二大常见的原发性肝脏恶性肿瘤,通常发生在非肝硬化肝脏中,根据大体形态可分为三种类型:肿块型、胆管周围浸润型和胆管内生长型。其中,肿块型肝内 CC 最为常见,表现为均匀肿块,边缘不规则但清晰,动脉晚期呈外周强化,肿瘤中央呈纤维间质样延迟强化。一些影像学特征,如强化模式和扩散受限程度,已被认为是肿块型 CC 的预后标志物。肝细胞癌(HCC)是最常见的原发性肝脏恶性肿瘤,通常起源于肝硬化肝脏。然而,约 20%的 HCC 涉及非肝硬化肝脏(以下简称非肝硬化 HCC),由于缺乏对非肝硬化肝脏患者的监测,非肝硬化 HCC 往往在晚期被发现。除 CC 和 HCC 以外的原发性肝脏恶性肿瘤如血管肉瘤、未分化胚胎肉瘤等较为罕见,影像学诊断往往较为困难。本文简要概述了非肝硬化肝脏原发性恶性肿瘤的流行病学、危险因素和影像学特征。了解非肝硬化肝脏原发性恶性肿瘤的影像学表现、易患临床特征和鉴别诊断,有助于放射科医生充分评估这些肿瘤,并制定最佳的治疗方案。

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