Biliary Cystadenoma and Cystadenocarcinoma: CT and Other Imaging Manifestations

膽道囊腺瘤與囊腺癌的電腦斷層與其他影像學表徵

邱怡友(Yi-You Chiou) ； 姜仁惠(Jen-Huey Chiang) ； 李潤川(Rheun-Chuan Lee) ； 曾修山(Hsiuo-Shan Tseng) ； 張國明(Kuo-Ming Chang) ； 黃振義(Jen-I Hwang) ； 鄭慧正(Hui-Cheng Cheng) ； 周宜宏(Yi-Hong Chou) ； 于俊(Chun Yu)

《中華放射線醫學雜誌》 21卷4期 (1996/08) Pp. 197-204

摘要

膽道囊腺瘤與囊腺癌是罕見的膽道腫瘤，通常位於肝臟內。病理學上的特徵是多房性的囊狀病灶，臨床上與實驗室的表徵是非特異性的。
我們回溯性分析在過去十年中本院的九例病人的電腦斷層影像表徵，其中二例是膽道囊腺瘤，七例是膽道囊腺癌。此外也簡潔敘述了超音波，經內視鏡回溯膽道攝影，經皮穿刺肝臟膽道攝影、血管攝影與磁振造影等各項影像學的表徵。
所有七例膽道囊腺癌都呈現多房性囊狀病灶，四例位於肝左葉，三例位於肝右葉，其他的電腦斷層影像表徵有：乳頭狀突起或囊壁結節、局部性囊壁增厚、總膽管與肝內膽管擴張、肝葉萎縮、囊壁鈣化、出血、以及膽道內結石。一例的膽道囊腺瘤呈現多房性囊狀病灶，合併有左肝葉萎縮、總膽管擴張與局部囊壁變厚。另一例則呈現單房性囊狀病灶，位於左葉，沒有局部囊壁變厚。此外，這二例病人都沒有出現乳頭狀突起或囊壁結節、囊壁鈣化、出血、以及膽道內結石。有七例病人接受手術腫瘤切除，兩例病人接受剖腹探查術與切片。
總之，在診斷膽道囊腺瘤與囊腺癌上，電腦斷層扮演了一個重要的角色。當一個肝內的多房性囊狀腫瘤合併有總膽管與肝內膽管擴張時，首先就應該考慮是否有此類腫瘤的可能。此外若合併有乳頭狀突起或囊壁結節、囊壁鈣化、出血、以及膽道內結石時，則產生膽道囊腺癌的可能性就會大增。

關鍵字

膽管，電腦斷層 ； 膽管，腫瘤 ； 肝腫瘤

並列摘要

Biliary cystadenoma and cystadenocarcinoma are rare biliary ductal neoplasms, usually intrahepatic in location, characterized pathologically by a multilocular cystic lesion. Clinical manifestations and laboratory data are nonspecific.
We retrospectively analyzed the computed tomography (CT) scan appearances of nine patients with pathologically proved biliary cystadenoma (2 patients) or cystadenocarcinoma (7 patients). Imaging findings of sonography, endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography, angiography, and magnetic resonance imaging were briefly presented. All the seven cases of biliary cystadenocarcinoma revealed multilocular cystic lesions in the liver, four in the left lobe and three in the right lobe. Other CT findings included: papillary projection/mural nodule (6/7) or focal wall thickening (1/7), common bile duct (CBD) and intrahepatic bile ducts (IHD) dilatation, hepatic lobe atrophy (5/7), wall calcification (4/7), hemorrhage (2/7), and IHD stones (2/7). One case of biliary cystadenoma showed a multilocular intrahepatic cystic lesion with left hepatic lobe atrophy, CBD dilatation and focal wall thickening. The other case showed an unilocular cystic lesion in the left hepatic lobe without evidence of focal wall thickening. No definite papillary projection/mural nodule, wall calcification, hemorrhage, or IHD stones could be identified in both cases of biliary cystadenoma. All the patients received surgical tumor removal (7/9) or exploratory laparotomy with incisional biopsy (2/9).
In conclusion, CT plays an important role in the diagnosis of biliary cystadenoma and cystadenocarcinoma. Biliary cystadenoma and cystadenocarcinoma should be the primary diagnostic consideration when one detects a hepatic multilocular cystic mass connected to the biliary system with CBD and IHD dilatation. The presence of papillary projection or mural nodule, wall calcification, hemorrhage, and IHD stones may increase the possibility of biliary cystadenocarcinoma.

並列關鍵字

Bile ducts, CT ； Bile ducts, neoplasms ； Liver, neoplasms