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目的研究肝脏局灶性结节性增生(FNH)临床及病理组化表现,旨在提高其诊断治疗水平。方法回顾分析2000～2005年第二军医大学东方肝胆医院46例经病理证实FNH病例的临床、影像学、病理和免疫组化资料。结果共46例FNH患者,均为单发;男性28例,女性18例,平均年龄35.5岁;病灶位于右叶28例,左叶13例,中肝叶4例,尾状叶1例;病灶直径1.3～10cm,平均4.34cm;术前诊断与术后病理相符者15例(32.61%),2例经肝脏穿刺活检病理诊断为FNH;术前误诊为原发性肝细胞癌24例(52.17%),误诊为肝细胞腺瘤2例(4.35%),误诊为肝血管瘤3例(6.52%);免疫组化:CD34、CK18、pCEA、Hep-1均为阳性,CA19-9、P53均为阴性,CK19阳性21例,PCNA阳性18例。结论多数FNH不需手术治疗,但由于与HCA、HCC等疾病难以鉴别,大部分患者经外科手术切除后病理证实,故术前鉴别诊断十分重要,合理检查提高疾病诊断率是关键。
Objective To study the clinical and histopathological features of focal nodular hyperplasia (FNH) in the liver in order to improve its diagnosis and treatment. Methods The clinical, radiological, pathological and immunohistochemical data of 46 FHH cases confirmed by pathology in Eastern Hepatobiliary Hospital of the Second Military Medical University from 2000 to 2005 were retrospectively analyzed. Results A total of 46 cases of FNH patients, were single; 28 males and 18 females, mean age 35.5 years; lesions in the right lobe 28 cases, left lobe 13 cases, 4 cases of lobe, caudate lobe 1 case; lesions 15 cases (32.61%) had preoperative diagnosis and postoperative pathological diagnosis, 2 cases were diagnosed as FNH by pathological examination of liver biopsy; 24 cases were diagnosed as primary hepatocellular carcinoma before operation (52.17 %), Misdiagnosed as hepatocellular adenoma in 2 cases (4.35%), misdiagnosed as hepatic hemangioma in 3 cases (6.52%); Immunohistochemistry: CD34, CK18, pCEA, Hep-1 were positive, CA19-9, P53 All were negative, CK19 positive in 21 cases, PCNA positive in 18 cases. Conclusions Most of FNH need not be treated surgically. However, because it is difficult to identify the diseases such as HCA and HCC, most of the patients are pathologically confirmed after surgical resection. Therefore, it is very important to diagnose preoperatively.