肝细胞癌、肝脏肉瘤样癌临床表现、磁共振特征比较分析

摘要/Abstract

摘要： 目的比较肝脏肉瘤样癌(HSC)与肝细胞癌(HCC)的临床表现、磁共振(MRI)特征。方法选择2010年1月至2021年6月HSC患者12例,HCC患者30例。比较HSC、HCC患者临床表现、MRI特征。比较采用卡方检验。结果 HSC、HCC患者中有临床症状的分别为9例、8例,差异有统计学意义(χ²=8.311,P<0.05)。HSC患者HBV感染、慢性肝脏疾病为6例、7例,HCC为28例(93.3%)、28例(93.3%),差异有统计学意义(χ²=-10.438,-7.560,P<0.05)。HSC患者临床分期Ⅰ/Ⅱ、Ⅲ/Ⅳ为2例、10例,HCC为19例(63.3%)、11例(36.7%),差异有统计学意义(χ²=-7.467,P<0.05);HSC患者CA125上升、CA199上升及CEA上升为5例、4例及3例,HCC为0、0及0例,差异有统计学意义(χ²=14.189,11.053,8.077,P<0.05)。HSC患者MRI特征中肿瘤直径、邻近胆管扩张、假包膜为(6.1±1.3)cm、 6例及5例,HCC为(4.2±1.0)cm、 2例(6.7%)及25例(83.3%),差异有统计学意义(t=7.308,χ²=10.438,-7.292,P<0.05)。HSC患者中快进快出、持续增强、周边增强、渐进增强、衰退及供血不足为0、4、0、7、0及1例,HCC为28例(93.3%)、1例(3.3%)、0、0、1例(3.3%)及0,差异有统计学意义(χ²=-36.925,P<0.05);HSC患者肝内转移、淋巴结肿大为5例、4例,HCC为4例(13.3%)、1例(3.3%),差异有统计学意义(χ²=4.087,7.356,P<0.05)。结论 HSC以腹痛、乏力、发热和黄疸等临床症状常见,同时血清肿瘤标志物CA125、CA199及CEA异常升高。此外,HSC患者MRI特征中以假包膜、渐进/持续增强、肝内转移及淋巴结肿大常见。

关键词: 肝脏肉瘤样癌, 肝细胞癌, MRI增强模式

Abstract: Objective To investigate the clinical manifestations and magnetic resonance imaging (MRI) features of sarcomatoid hepatocellular carcinoma (SHCC) and hepatocellular carcinoma (HCC), and to provide valuable data for differential diagnosis of SHCC. Methods A total of 12 patients (10 males and 2 females) with SHCC admitted to our hospital from January 2010 to June 2021 were enrolled, with an average age of (59.4 ± 11.7) years. Meanwhile, 30 cases of HCC in the same period were included as control group. The clinical manifestations and MRI features of SHCC and HCC patients were compared. T-test and chi-square test were used for comparison. Results The incidence rates of clinical symptoms in SHCC and HCC patients were 9 (75.0%) and 8 (26.7%), the difference was statistically significant (χ²=8.311, P<0.05). In SHCC group, there were 6 cases (50.0%) with hepatitis B virus (HBV) infection and 28 cases (93.3%) with chronic liver disease, which were significantly different from control group [28 cases (93.3%) and 28 cases (93.3%)] (χ²=-10.438, -7.560, P<0.05). The numbers of stage I/II, III/IV in SHCC group were 2 cases (16.7%) and 10 cases (83.3%), which were significantly different from those in control group [19 cases (63.3%) and 11 cases (36.7%)] (χ²=-7.467, P<0.05). In SHCC group, carcinoma antigen 125 (CA125), carcinoma antigen 199 (CA199) and carcinoma embryonic antigen (CEA) increased in 5 cases (41.7%), 4 cases (33.3%) and 3 cases (25.0%), which were significantly different from control group[0 (0), 0 (0) and 0 (0)] (χ²=14.189, 11.053, 8.077, P<0.05). The MRI features of SHCC patients were tumor diameter in (6.1±1.3) cm, 6 (50.0%) with cholangiectasis and 5 (41.7%) with pseudocapsule, which were significantly different from control group [(4.2 ± 1.0) cm, 2 (6.7%) and 25 (83.3%)] (t=7.308, χ²=10.438, -7.292, P<0.05). In SHCC group, "fast-forward and fast-out", continuous enhancement, peripheral enhancement, gradual enhancement, recession and insufficient blood supply were 0 (0), 4 (33.3%), 0 (0), 7 (58.3%), 0 (0) and 1 (8.3%), which were significantly different from control group [28 cases (93.3%), 1 cases (3.3%), 0 (0), 1 case (8.3%) and 0 (0)] (χ²=-36.925, P<0.05). There were 5 cases (41.7%) with intrahepatic metastasis and 4 cases (33.3%) with lymph node enlargement in SHCC group, which were significantly different from control group [4 cases (13.3%) and 1 case (3.3%)] (χ²=4.087, 7.356, P<0.05). Conclusion Clinical symptoms such as abdominal pain, fatigue, fever and jaundice are common in patients with SHCC, and serum tumor markers including CA125, CA199, CEA are abnormally elevated. In addition, false capsule, progressive/continuous enhancement, intrahepatic metastasis and lymph node enlargement are typical MRI features of patients with SHCC. The manifestations above-mentioned will contribute to the differential diagnosis of SHCC.

Key words: Sarcomatoid hepatocellular carcinoma, Hepatocellular carcinoma, Magnetic resonance imaging enhancement mode

王奇航, 郭勇邦. 肝细胞癌、肝脏肉瘤样癌临床表现、磁共振特征比较分析[J]. 肝脏, 2022, 27(9): 983-985.

WANG Qi-hang, GUO Yong-bang. Comparative analysis of clinical manifestations and MRI features between hepatocellular carcinoma and sarcomatoid hepatocellular carcinoma[J]. Chinese Hepatolgy, 2022, 27(9): 983-985.

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