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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (11): 89-95.doi: 10.6040/j.issn.1671-7554.0.2022.0572

• 临床医学 • 上一篇    下一篇

合并乙肝肝硬化的肝上皮样血管内皮瘤1例报道并文献复习

李祥泽1,2,王先明2,宋歌声3,崔晶4,孙凯2,王皓晨2,王天成2,韩绍奇2,田虎1,2   

  1. 1.山东大学齐鲁医学院 山东省千佛山医院普通外科学, 山东 济南 250014;2.山东第一医科大学第一附属医院(山东省千佛山医院)普通外科学, 山东 济南 250014;3.山东第一医科大学第一附属医院(山东省千佛山医院)放射科, 山东 济南 250014;4.山东第一医科大学第一附属医院(山东省千佛山医院)病理科, 山东 济南 250014
  • 出版日期:2022-11-10 发布日期:2022-11-04
  • 通讯作者: 田虎. E-mail:tianhu6585@163.com
  • 基金资助:
    山东省自然科学基金(ZR2019MH116)

Hepatic epithelioid hemangioendothelioma complicated with hepatitis B cirrhosis: a case report and literature review

LI Xiangze1,2, WANG Xianming2, SONG Gesheng3, CUI Jing4, SUN Kai2, WANG Haochen2, WANG Tiancheng2, HAN Shaoqi2, TIAN Hu1,2   

  1. 1. Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, Shandong, China;
    2. Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong, China;
    3. Department of Radiology, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong, China;
    4. Department of Pathology, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong, China
  • Online:2022-11-10 Published:2022-11-04

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摘要： 目的 分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床特点及影像学特征,从而提高对此病的认识,减少误诊,进一步指导临床诊疗。 方法 收集并分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床资料,检索相关病例报道并进行文献复习。 结果 患者,51岁,男性,因“体检中发现肝脏孤立占位性病变3 d余”入院,查体未见特殊异常。肿瘤标志物未见明显异常。肝脏MRI:平扫不具有特征性,扩散加权成像(DWI)和表观扩散系数(ADC)提示病变边缘部分弥散受限,中央区弥散不受限,提示合并坏死;增强扫描与CT类似,也是呈周边不均匀强化,并有向内填充的趋势,延迟期开始廓清。术后病理证实为肝上皮样血管内皮瘤。 结论 在临床诊疗过程中,遇到肝脏实性占位性病变、影像学没有典型肝细胞癌、胆管细胞癌及肝血管瘤等常见病表现时,尤其是影像学提示典型的“包膜回缩征”“靶征”或“棒棒糖征”时,应考虑到本病可能。

关键词: 肝上皮样血管内皮瘤, 乙肝肝硬化, 影像学表现, 鉴别诊断

Abstract: Objective To analyze the clinical and imaging characteristics of a patient with hepatic epithelioid hemangioendothelioma misdiagnosed preoperatively as hepatocellular carcinoma complicated with hepatitis B cirrhosis, so as to improve the understanding of this disease, reduce misdiagnosis and guide clinical diagnosis and treatment. Methods The clinical data of the patient were collected and analyzed, relevant case reports were retrieved and literature review was reviewed. Results The patient, a 51-year-old male, was admitted due to “isolated liver space-occupying lesions found in physical examination for more than 3 days”, and no other special abnormalities were obsevred. There were no obvious abnormalities in tumor markers. MRI of liver showed that plain scan was not characteristic. DWI and ADC suggested limited diffusion at the edge of the lesion, and unrestricted diffusion at the central area, suggesting combined necrosis. Enhanced scanning showed similar results, presenting uneven peripheral enhancement, which tended to invade inwards and clear during the delay period. Postoperative pathology confirmed hepatic epithelioid hemangioendothelioma. Conclusion In clinical diagnosis and treatment, the possibility of liver solid space-occupying lesions should be considered when there are no typical manifestations of common diseases such as hepatocellular carcinoma, cholangiocarcinoma and hepatic hemangioma, especially when imaging suggests typical “capsule retraction sign”, “target sign” or “lollipop sign”.

Key words: Hepatic epithelioid hemangioendothelioma, Hepatitis B cirrhosis, Imaging findings, Differential diagnosis

中图分类号: 

  • R735.7
[1] Ishak KG, Sesterhenn IA, Goodman ZD, et al. Epithelioid hemangioendothelioma of the liver: a clinicopathologic and follow-up study of 32 cases [J]. Hum Pathol, 1984, 15(9): 839-852.
[2] Studer LL, Selby DM. Hepatic epithelioid hemangioendothelioma [J]. Arch Pathol Lab Med, 2018, 142(2): 263-267.
[3] Singh A, Sood N, Puri HK, et al. Primary hepatic epithelioid hemangioendothelioma: diagnostic dilemmas in cytology and histology [J]. J Oncol Pract, 2016, 12(4): 394-396.
[4] Gurung S, Fu H, Zhang WW, et al. Hepatic epithelioid hemangioendothelioma metastasized to the peritoneum, omentum and mesentery: a case report [J]. Int J Clin Exp Pathol, 2015, 8(5): 5883-5889.
[5] Lotfallam M, Folpe AL, Fritchie KJ, et al. Hepatic YAP1-TFE3 rearranged epithelioid hemangioendothelioma [J]. Case Rep Gastrointest Med, 2019, 2019: 7530845. doi: 10.1155/2019/7530845.
[6] Bourgeau M, Martinez A, Deeb KK, et al. Cytologic features of hepatic YAP1-TFE3 rearranged epithelioid hemangioendothelioma [J]. Diagn Cytopathol, 2021, 49(12):E447-E452.
[7] Yang JW, Li Y, Xie K, et al. Spontaneous rupture of hepatic epithelioid hemangioendothelioma: a case report [J]. World J Gastroenterol, 2017, 23(1): 185-190.
[8] Elleuch N, Dahmani W, Aida ben S, et al. Hepatic epithelioid hemangioendothelioma: a misdiagnosed rare liver tumor [J]. Presse Med, 2018, 47(2): 182-185.
[9] Mcglynn KA, Petrick JL, El-serag HB. Epidemiology of hepatocellular carcinoma [J]. Hepatology, 2021, 73(Suppl 1): 4-13.
[10] 王旋, 戴炳华, 杨诚, 等. 肝上皮样血管内皮瘤的诊断与治疗[J]. 中华肝胆外科杂志, 2017, 23(4): 222-224. WANG Xuan, DAI Binghua, YANG Cheng, et al. Diagnosis and treatment of hepatic epithelioid hemangioendothelioma [J]. Chin J Hepatobiliary Surg, 2017, 23(4): 222-224.
[11] Virarkar M, Saleh M, Diab R, et al. Hepatic hemangioendothelioma: an update [J]. World J Gastrointest Oncol, 2020, 12(3): 248-266.
[12] Epelboym Y, Engelkemier DR, Thomas-chausse F, et al. Imaging findings in epithelioid hemangioendothelioma [J]. Clin Imaging, 2019, 58: 59-65. doi: 10.1016/j.clinimag.2019.06.002.
[13] Zhou L, Cui MY, Xiong J, et al. Spectrum of appearances on CT and MRI of hepatic epithelioid hemangioendothelioma [J]. BMC Gastroenterol, 2015, 15: 69. doi: 10.1186/s12876-015-0299-x.
[14] Alomari AI. The lollipop sign: a new cross-sectional sign of hepatic epithelioid hemangioendothelioma [J]. Eur J Radiol, 2006, 59(3): 460-464.
[15] 吴珂, 许伟, 常瑞萍, 等. 肝上皮样血管内皮细胞瘤MRI表现[J]. 中华肝胆外科杂志, 2018, 24(6): 367-370. WU Ke, XU Wei, CHANG Ruiping, et al. MRI feature of hepatic epithelioid hemangioendothelioma [J]. Chin J Hepatobiliary Surg, 2018, 24(6): 367-370.
[16] Roth CG, Mitchell DG. Hepatocellular carcinoma and other hepatic malignancies: MR imaging [J]. Radiol Clin North Am, 2014, 52(4): 683-707.
[17] Mulazzani L, Alvisi M. Imaging findings of hepatic epithelioid hemangioendothelioma and fibrolamellar hepatocellular carcinoma: a critical appraisal of current literature about imaging features of two rare liver cancers [J]. Transl Cancer Res, 2019(Suppl 3): S297-S310. doi: 10.21037/tcr.2018.11.33.
[18] Bruegel M, Muenzel D, Waldt S, et al. Hepatic epithelioid hemangioendothelioma: findings at CT and MRI including preliminary observations at diffusion-weighted echo-planar imaging [J]. Abdom Imaging, 2011, 36(4): 415-424.
[19] Kou K, Chen YG, Zhou JP, et al. Hepatic epithelioid hemangioendothelioma: Update on diagnosis and therapy [J]. World J Clin Cases, 2020, 8(18): 3978-3987.
[20] Lai Q, Feys E, Karam V, et al. Hepatic epithelioid hemangioendothelioma and adult liver transplantation: proposal for a prognostic score based on the analysis of the ELTR-ELITA registry [J]. Transplantation, 2017, 101(3): 555-564.
[21] Merriam P, Nathenson MJ. Liver transplantation for hepatic epithelioid hemangioendothelioma [J]. Cancer, 2021, 127(20): 3714-3716.
[22] Bostancı EB, Karaman K, Turhan N, et al. Selective internal radiotherapy for hepatic epithelioid hemangioendothelioma [J]. Turk J Gastroenterol, 2014, 25(Suppl 1): 252-253. doi: 10.5152/tjg.2014.4286.
[23] Mehrabi A, Hoffmann K, Weiss KH, et al. Long term follow up after resection emphasizes the role of surgery in primary hepatic epithelioid hemangioendothelioma [J]. Ann Med Surg(Lond), 2016, 11: 1-4. doi: 10.1016/j.amsu.2016.03.002.
[24] Soape MP, Verma R, Payne JD, et al. Treatment of hepatic epithelioid hemangioendothelioma: finding uses for thalidomide in a new era of medicine [J]. Case Rep Gastrointest Med, 2015, 2015: 326795. doi: 10.1155/2015/326795.
[25] Gan LU, Chang R, Jin H, et al. Typical CT and MRI signs of hepatic epithelioid hemangioendothelioma [J]. Oncol Lett, 2016, 11(3): 1699-1706.
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