CT表现为“水肿环征”的肝脏炎性假瘤：一例报道

Abstract

男，57岁，主诉右上腹不适伴右肝区隐痛1个月，既往无肝炎。体检：一般情况良好，皮肤巩膜无黄染，腹软，肝脾未触及。化验：WBC 9.0 × 109/L，Hb 97 g/L，白蛋白33.4 g/L，球蛋白35.3 g/L，丙氨酸转氨酶20 IU/L。甲胎蛋白(AFP) 2.6 μg/L (0~20.0 μg/L)、癌胚抗原(CEA) 3.0 μg/L、糖类抗原CA19-9 16 μg/L。B超检查见左肝内叶有55 × 47 mm大小低回声团块，境界尚清楚，其内部回声不均匀，可探及动脉型血流信号，提示左肝占位性病变、肝癌首先考虑。CT扫描提示左肝内叶可探及34 mm椭圆形等密度灶，病灶周边见环形低密度带，增强扫描后更为清楚(“水肿环征”)，余肝内多发小囊状低密度影，左肾也见小囊肿，诊断为左肝内占位性病变(肝癌首先考虑)、右肝多发小囊肿及左肾小囊肿。全身麻醉下剖腹探查行不规则肝切除，术中见左肝内叶有一个6.5 cm大小肿物，表面呈灰白色，边界清楚。术后病理组织学检查见大量淋巴细胞和浆细胞浸润以及纤维肉芽组织增生，符合炎性假瘤。术后恢复顺利，随诊10年无复发。 A 57 years old male patient’s chief complaint is the right epigastric discomfort associated with dull pain, no past history of hepatitis. On physical examination, he was in good general condition, no yellow stain of skin and sclera, soft abdomen with impalpable liver and spleen. Laboratory exam-ination revealed that WBC was 9.0 × 109/L, Hb 97 g/L, serum albumin 33.4 g/L, serum globulin 35.3 g/L, alanine aminotransferase 20 IU/L, alpha-fetoprotein (AFP) 2.6 μg/L (0 - 20.0 μg/L), car-cinoembryonic antigen (CEA) 3.0 μg/L, and carbohydrate CA19-9 16 μg/L. Ultrasonography revealed that a hypoechoic tumor about 55 × 47 mm located at left liver, with clear boundary, and uneven the echo in the tumor, and blood stream was detectable, suggesting left liver occupying lesion with the predominance of liver cancer. A tumor of 34 mm with elliptical density rang in the left liver on plain CT scanning, and hypodensity band around the tumor was found, it was enhanced by enhanced CT scanning (“edema rime sign”). The multiple liver and kidney cyst were also found, and the diagnosis was left liver occupying lesion with the predominance of liver cancer, with multiple liver and kidney cyst. An irregular hepatectomy was performed under general anesthesia, and a tumor about 6.5 cm in diameter was found in the left liver, with gray surface and clear boundary. The postoperative histopathology demonstrated an amount of lymphocytes and plasma cells infiltration in the tumor and hyperplasia of fibrous tissues. The recovery after surgery was smoothly, and there was no recurrence case on 10-year follow-up.