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Necrotic Hepatic Hemangioma Mimicking Liver Metastasis at the MR Imaging: A Case Report
壞死性肝臟血管瘤之核磁共振影像似肝轉移癌：病例報告
摘要
一位73歲結腸癌病患於10年前接受過手術治療，然最近2至3月他每天約水瀉3次。故他入院接受檢查，核磁共振影像顯示有一個顯影不均勻的橫結腸癌及左肝葉的一個邊緣清楚9×8.2公分大小腫塊，此肝腫塊在注射顯影劑前的T1為主影像中（T1WI）是等至高訊號的表現，在T2為主影像中（T2WI）是低訊號而週邊有點狀高訊號。此病例被術前診斷為結腸癌伴有肝轉移。然在接受橫至降結腸切除及左肝葉切除手術後，病理顯示為－9.8×9.0×7.5公分大小的肝腫塊，黃白色壞死組織幾乎佔滿整個腫塊而邊緣有暗紅色血塊狀物，病理診斷為肝血管瘤併有橫結腸黏液性腺癌。 此肝血管瘤之核磁共振影像並不典型，其非典型表徵可能是因腫瘤有顯著出血性壞死。在此我們報告這少見病例，並建議當看到相似影像時要考慮到非典型肝血管瘤的可能。
並列摘要
73-year-old male was a victim of sigmoid colon cancer. He received a sigmoid-colectomy 10 years ago. He suffered from watery diarrhea about 3 times per day for 2-3 months recently. Magnetic resonance imaging (MRI) showed a heterogeneously enhanced mass in the transverse colon and a 9x8.2 cm well-marginated mass in the left lobe of the liver. The hepatic tumor showed mixed signal intensity on Ti-weighted imaging (T1WI), low signal intensity with small spotted high signals on T2-weighted imaging (T2WI). Recurrent colon cancer with liver metastasis was impressed. The patient received transverse and descending-colectomy and left hepatectomy. Histopathological examination showed solitary hepatic mass virtually filled with yellowish white necrotic material. A dark-red, blood clot-like substance at the periphery was noted in gross. In microscopic examination, the liver tumor was composed entirely of fibrin clot and blood clot at center with closely aggregated, ectactic and congested thin- walled vessels at small focal area at the periphery of the tumor. Hepatic hemangioma coexisting with a transverse colon mucinous adenocarcinoma was diagnosed by the pathologist. The MRI findings did not showed the characteristics of hepatic hemangioma. The atypical appearance was due to marked hemorrhagic necrosis of the tumor. We report this unusual case, and suggest to consider the possibility of atypical hemangioma in liver masses with similar imaging patterns.
延伸閱讀
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