Sato Akio, Saito Kazuhiro, Abe Koichiro, Sugimoto Katsutoshi, Nagao Toshitaka, Sukeda Aoi, Yunaiyama Daisuke
Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Tokyo, Japan.
World J Clin Cases. 2023 Jun 26;11(18):4377-4383. doi: 10.12998/wjcc.v11.i18.4377.
As hepatic myelolipoma is rarely encountered, its radiological diagnosis using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) is challenging. Hepatic myelolipoma is similar to fat-contained hepatic lesions seen in hepatocellular carcinoma and angiomyolipoma. Therefore, further development of techniques to diagnose hepatic myelolipoma is warranted.
A 44-year-old obese man was found to have a hepatic lesion during his medical checkup. The lesion was 50 mm × 57 mm in size and was detected in segment 8 (S8) of the liver by US. The patient was diagnosed with hepatic lesion 20 years ago, but it was left unresolved. The patient had no symptoms, liver dysfunction, hepatitis virus antibody, or tumor marker elevation. Plain CT showed a well-defined lesion in S8 of the liver. The central and peripheral areas of the lesion primarily exhibited fat density and hypodensity, respectively. MRI revealed a capsule-like structure. Biopsy was performed to address the probability of hepatocellular carcinoma. The lesion was pathologically confirmed as a myelolipoma. Bone marrow scintigraphy performed using InCl revealed accumulation of the radiopharmaceutical in the soft tissue component, except in the fat-dominant part of the tumor, as well as in the surrounding liver parenchyma due to the presence of reticuloendothelial cells in the liver.
This is the first report on the diagnosis of hepatic myelolipoma using InCl scintigraphy. The effectiveness of bone marrow scintigraphy for diagnosing hepatic myelolipoma might be limited. As radiopharmaceuticals accumulate in both hematopoietic and reticuloendothelial cells, the accumulation of radiopharmaceuticals in the lesion is obscure.
由于肝髓脂肪瘤罕见，使用超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）对其进行放射学诊断具有挑战性。肝髓脂肪瘤类似于肝细胞癌和血管平滑肌脂肪瘤中所见的含脂肪肝病变。因此，有必要进一步开发诊断肝髓脂肪瘤的技术。
一名44岁肥胖男性在体检时发现肝脏有病变。该病变大小为50mm×57mm，超声检查发现位于肝脏第8段（S8）。该患者20年前被诊断为肝脏病变，但未得到解决。患者无症状、肝功能正常、无肝炎病毒抗体或肿瘤标志物升高。平扫CT显示肝脏S8段有一个边界清晰的病变。病变的中央和周边区域分别主要表现为脂肪密度和低密度。MRI显示有包膜样结构。为排除肝细胞癌的可能性进行了活检。病理证实该病变为髓脂肪瘤。使用InCl进行的骨髓闪烁显像显示，放射性药物在软组织成分中蓄积，但肿瘤的脂肪占主导部分除外，并且由于肝脏中存在网状内皮细胞，放射性药物也在周围肝实质中蓄积。
这是首例使用InCl闪烁显像诊断肝髓脂肪瘤的报告。骨髓闪烁显像对诊断肝髓脂肪瘤的有效性可能有限。由于放射性药物在造血细胞和网状内皮细胞中均有蓄积，病变中放射性药物的蓄积情况不明显。
