Stevens W R, Johnson C D, Stephens D H, Nagorney D M
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 1995 May;164(5):1153-8. doi: 10.2214/ajr.164.5.7717223.
The purpose of this study was to report the stage of fibrolamellar carcinoma at presentation and the imaging findings of postoperative recurrent tumor in an aggressively managed population and to assess the implications of those findings relative to the patients' management.
Imaging studies in 10 patients with pathologically proved fibrolamellar carcinoma were reviewed. Preoperative studies included CT (n = 10), sonography (n = 8), and MR imaging (n = 2). Postoperative studies included CT (n = 9), sonography (n = 4), and MR imaging (n = 1). Imaging findings were correlated with clinical and surgical follow-up data. Patients were followed up for 2-75 months (median, 26 months).
At presentation, seven (70%) of 10 patients had metastatic lymphadenopathy. Seven patients (70%), including four with lymph node metastasis, had tumor resections with intent to cure. Postoperative imaging studies revealed recurrent tumor in all seven of these patients, including six patients (86%) who had intrahepatic recurrence with or without lymph node metastasis after 6-18 months, and one patient (14%) who had distant metastases 66 months postoperatively. Recurrent lesions were subsequently resected in three (43%) of seven patients, who were disease-free at a mean of 8 months after their second resection. Five patients died after 9 months mean survival, and two patients were alive with residual tumor after 3 months mean follow-up.
Fibrolamellar carcinomas are often of advanced stage at diagnosis. Recurrence after resection with intent to cure is common. Early and frequent follow-up imaging is necessary for optimizing surgical management in patients with fibrolamellar carcinoma.
本研究旨在报告在积极治疗的人群中，纤维板层癌初诊时的分期以及术后复发性肿瘤的影像学表现，并评估这些发现对患者治疗的影响。
回顾了10例经病理证实为纤维板层癌患者的影像学研究。术前检查包括CT（n = 10）、超声（n = 8）和磁共振成像（n = 2）。术后检查包括CT（n = 9）、超声（n = 4）和磁共振成像（n = 1）。影像学表现与临床及手术随访数据相关。对患者进行了2至75个月的随访（中位时间为26个月）。
初诊时，10例患者中有7例（70%）出现转移性淋巴结病。7例患者（70%），包括4例有淋巴结转移的患者，接受了旨在治愈的肿瘤切除术。术后影像学研究显示，这7例患者均出现复发性肿瘤，其中6例（86%）在6至18个月后出现肝内复发伴或不伴淋巴结转移，1例（14%）在术后66个月出现远处转移。7例患者中有3例（43%）随后切除了复发病变，二次切除后平均8个月无病生存。5例患者在平均9个月的生存期后死亡，2例患者在平均3个月的随访后仍有残留肿瘤存活。
纤维板层癌在诊断时通常处于晚期。旨在治愈的切除术后复发很常见。对于纤维板层癌患者，早期且频繁的随访影像学检查对于优化手术治疗是必要的。
