Maruyama Shigeo, Koda Masahiko, Matono Tomomitsu, Isomoto Hajime
Department of Internal Medicine, Maruyama Medical Clinic, Hamada, Shimane 697-0034, Japan.
Department of Internal Medicine, Hino Hospital, Hino, Tottori 689-4504, Japan.
Mol Clin Oncol. 2021 Apr;14(4):83. doi: 10.3892/mco.2021.2245. Epub 2021 Feb 26.
Little is known concerning causal factors associated with the size and echogenicity of hepatic hemangiomas. The aim of the present study was to investigate the associations between tumor size and echo pattern and coagulation factors, and to elucidate the growth pattern of hemangiomas. In 214 consecutive patients with hepatic hemangiomas, ultrasonography was performed to determine total tumor number, size, echogenicity and location, and serum laboratory tests for liver function and coagulation factors were carried out. The ultrasonographic appearance of hemangiomas was homogeneous in 75.7% of cases and mixed in 24.3% of cases. A mixed echo pattern was seen in 1 out of 145 masses (0.7%) with a diameter <20 mm, in 30 out of 48 (62.5%) with a diameter of 20-40 mm, and in all of the 21 (100%) with a diameter >40 mm. Platelet counts (P<0.0001) and fibrinogen levels (P<0.01) were lower in patients with larger and mixed tumors. Levels of thrombin-antithrombin III complex (TAT), D-dimer, and fibrin and fibrinogen degradation products (FDP) were significantly elevated along with an increase in tumor size (all P<0.0001), and the number of patients with the abnormal values of TAT, D-dimer, and FDP was significantly higher in the mixed group than in the homogeneous group (all P<0.0001). Fibrinogen (P<0.01), platelet count (P<0.001), portal vein diameter (P<0.0001), splenic index (P<0.01), and levels of TAT, D-dimer and FDP (all P<0.0001) were significantly associated with tumor size. Multivariate analysis revealed TAT, D-dimer and FDP as independent predictors of tumor size. The internal echo pattern became mixed as size increased. The size and echogenicity of hemangiomas were closely associated with coagulation factors. Therefore, it was speculated that differences in size and echogenicity were caused by intratumoral thrombosis and subsequent hemorrhage.
关于与肝血管瘤大小及回声性相关的病因因素，人们了解甚少。本研究的目的是调查肿瘤大小、回声模式与凝血因子之间的关联，并阐明血管瘤的生长模式。对214例连续性肝血管瘤患者进行了超声检查，以确定肿瘤总数、大小、回声性及位置，并进行了肝功能和凝血因子的血清实验室检测。血管瘤的超声表现75.7%为均匀性，24.3%为混合性。直径<20mm的145个肿块中有1个（0.7%）表现为混合回声模式，直径20 - 40mm的48个中有30个（62.5%），直径>40mm的21个全部（100%）表现为混合回声模式。较大及混合性肿瘤患者的血小板计数（P<0.0001）和纤维蛋白原水平（P<0.01）较低。随着肿瘤大小增加，凝血酶 - 抗凝血酶III复合物（TAT）、D - 二聚体以及纤维蛋白和纤维蛋白原降解产物（FDP）水平显著升高（均P<0.0001），且混合组中TAT、D - 二聚体和FDP值异常的患者数量显著高于均匀组（均P<0.0001）。纤维蛋白原（P<0.01）、血小板计数（P<0.001）、门静脉直径（P<0.0001）、脾脏指数（P<0.01）以及TAT、D - 二聚体和FDP水平（均P<0.0001）均与肿瘤大小显著相关。多变量分析显示TAT, D - 二聚体和FDP是肿瘤大小的独立预测因子。随着大小增加，内部回声模式变为混合性。血管瘤的大小和回声性与凝血因子密切相关。因此，推测大小和回声性的差异是由瘤内血栓形成及随后的出血所致。
