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中华消化病与影像杂志(电子版) ›› 2023, Vol. 13 ›› Issue (06) : 532 -534. doi: 10.3877/cma.j.issn.2095-2015.2023.06.035

病例报告

肝脏炎性假瘤样滤泡树突状细胞肿瘤CT表现一例
黄文鹏, 耿尚文, 刘肖楠, 刘晨晨, 李莉明, 高剑波()   
  1. 450052 郑州大学第一附属医院放射科
    450052 郑州大学第一附属医院病理科
  • 收稿日期:2023-06-29 出版日期:2023-12-01
  • 通信作者: 高剑波
  • 基金资助:
    国家自然科学基金(81971615)
  • Received:2023-06-29 Published:2023-12-01
引用本文:

黄文鹏, 耿尚文, 刘肖楠, 刘晨晨, 李莉明, 高剑波. 肝脏炎性假瘤样滤泡树突状细胞肿瘤CT表现一例[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 532-534.

患者女性,46岁。主诉:右上腹间断性疼痛3 d;体格检查未见明显异常;实验室检查:血常规、肝功能、肿瘤标志物指标正常,乙型肝炎表面抗原阴性,EB病毒DNA阴性(<5.00×102);既往体健,无肝炎、结核等传染病史,无家族遗传性病史。腹部CT检查:肝脏尾状叶见类圆形低密度肿块影,大小约5.2 cm×5.5 cm×6.2 cm,边界尚清,内密度不均,可见更低密度坏死区,平扫CT值约47 HU(图1A),增强扫描后动脉期呈中度不均匀强化,CT值约77 HU(图1B),内可见纡曲供血动脉(图1C),静脉期呈渐进性持续强化,CT值约80 HU(图1D);诊断考虑为原发性肝细胞癌。患者行肝尾状叶占位切除术,术中见肝尾状叶内大小约7.0 cm×5.0 cm×4.0 cm质硬肿块,边界不清,与周围组织中度粘连(图1E)。病理组织学检查:镜下见梭形肿瘤细胞散在分布于淋巴细胞、浆细胞中(图1F);免疫组化:CD35(+),CD21(局部+),CD23(局部+),CD43(+),CD3(+),CD20(局部+),Fascin(+),CK(-),EMA(-),Hepatocyte(-),AFP(-),CD117(少量细胞散在+),Dog-1(-),S-100(少量细胞散在+),ALK(-),CD34(-),Ki-67(约30%+);原位杂交:EBER(+);基因重排结果:存在多克隆性增生的T细胞群,排除T细胞淋巴瘤。病理诊断:肝脏炎性假瘤样滤泡树突状细胞肿瘤(inflammatory pseudotumor-like follicular dendritic cell tumor,IPT-like FDCT),肝脏切缘净。术后患者恢复良好,门诊及电话随访3年,未出现病灶复发及明显并发症。

图1 肝脏炎性假瘤样滤泡树突状细胞肿瘤图像注:1A CT平扫示肝脏尾状叶见类圆形低密度肿块,内见更低密度坏死区,平扫CT值约47 HU;1B动脉期呈中度不均匀强化,CT值约77 HU;1C动脉期MIP图像示病灶内纡曲供血动脉;1D静脉期图像示病灶持续强化,CT值约80 HU;1E术后大体图像;1F术后病理图像(HE染色,×100)。
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