Kiuchi Ryota, Sakaguchi Takanori, Kitajima Ryo, Furuhashi Satoru, Takeda Makoto, Hiraide Takanori, Morita Yoshifumi, Ushio Takasuke, Ishikawa Rei, Baba Satoshi, Takeuchi Hiroya
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Clin J Gastroenterol. 2019 Aug;12(4):361-366. doi: 10.1007/s12328-019-00946-2. Epub 2019 Feb 14.
Hepatic angiomyolipoma (AML) is a rare stromal tumor composed of variable admixtures of thick-walled vessels, smooth muscles and adipose tissue. One of the specific radiological findings of hepatic AML is an early drainage vein noted via enhanced computed tomography (CT). We report a case of hepatic AML showing early drainage veins into both the hepatic and portal vein. The case involved a 46-year-old woman who was referred to our hospital because of a giant hepatic tumor. CT revealed well-enhanced 14 cm and 1 cm tumors in the left and right lobes, respectively. Magnetic resonance imaging demonstrated the existence of adipose tissues in the larger tumor. Hepatic arteriography revealed early drainage veins draining into both the hepatic and portal vein. Based on a diagnosis of hepatic AML, left hepatectomy and partial hepatectomy were performed. Pathology revealed both tumors as hepatic AML based on human melanoma black-45 immuno-positivity. Hepatic AML with early drainage veins into both the hepatic and portal vein is rare. The dilated and retrogressive vein drains the abundant arterial blood flow of the tumor. The finding of early drainage veins into not only the hepatic vein but also the portal vein should be helpful for diagnosing hepatic AMLs.
肝血管平滑肌脂肪瘤（AML）是一种罕见的间质肿瘤，由厚壁血管、平滑肌和脂肪组织以不同比例混合组成。肝AML的特异性影像学表现之一是在增强计算机断层扫描（CT）中可见早期引流静脉。我们报告一例肝AML病例，该病例显示早期引流静脉同时汇入肝静脉和门静脉。该病例为一名46岁女性，因巨大肝肿瘤转诊至我院。CT显示左叶有一个强化良好的14厘米肿瘤，右叶有一个1厘米肿瘤。磁共振成像显示较大肿瘤内存在脂肪组织。肝动脉造影显示早期引流静脉同时汇入肝静脉和门静脉。基于肝AML的诊断，实施了左肝切除术和部分肝切除术。病理检查基于人黑素瘤黑色-45免疫阳性结果，证实两个肿瘤均为肝AML。肝AML的早期引流静脉同时汇入肝静脉和门静脉的情况较为罕见。扩张和迂曲的静脉引流肿瘤丰富的动脉血流。早期引流静脉不仅汇入肝静脉，还汇入门静脉这一发现有助于诊断肝AML。
