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Difficulty in Differentiating Hepatic Angiomyolipoma from Hepatocellular Carcinoma: A Case Report
鑑別診斷肝的血管肌肉脂肪瘤和肝細胞癌的難處：病例報告
摘要
分辨血管肌肉脂肪瘤和肝細胞癌在B型肝炎高盛行率的台灣是項困難的挑戰。一位四十四歲的女性在例行性健康檢查中發現肝腫塊：電腦斷層顯示一顆9×6.5×7公分不均勻質地的腫瘤在肝的左葉。動脈相時有顯影增強，但是有幾個低密度的區域一直沒顯影增強。血管攝影顯示緻密的血管增生，但沒有肝動脈和門靜脈廔管生成。 而在磁振造影的In-和Out-phase下確定是脂肪。開刀結果顯示是血管肌肉脂肪瘤。病理切片顯示HMB-45染色陽性，對血管肌肉脂肪瘤的診斷非常有專一性。雖然我們合併電腦斷層和磁振造影可以清楚的分辨脂肪的成分，但是對於和有脂肪變化的肝細胞癌卻無法做有效的辨識；即使血管攝影也無法分辨。主要的原因還是來自於血管肌肉脂肪瘤豐富且組成多變的成分所致。
並列摘要
Differentiating hepatic angiomyolipoma and hepatocellular carcinoma (HCC) is a critical issue in setting of which hepatocellular carcinoma is epidemic. A routine physical examination revealed a hepatic tumor in an asymptomatic 44-year old woman. Computer tomography (CT) revealed a 9×6.5×7 cm well-circumscribed heterogenous soft tissue mass which showed good contrast enhancement. Several low-density foci occupying inferior aspect of lateral segment of liver were also demonstrated. Angiography showed the tumor stain with coarse vessels at peripheral region without arterioportal shunt. In- and out-phase fast multiplanar spoiled GRASS sequence magnetic resonance imaging (MRI) confirmed fatty component of the corresponding low-density area. Pathology revealed mixed typed angiomyolipoma by characteristic HMB-45 immunomarker stain. While combining CT and MRI clearly demonstrates the presence of fat, the pattern of fat distribution does not allow satisfactory differentiation between angiomyolipoma and heatocellular carcinoma. Conclusive diagnosis was also not possible to be made by the use of angiography only.
延伸閱讀
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