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目的探讨肝血管平滑肌脂肪瘤(hepatic angiomyolipoma,HAML)的MRI表现及临床病理特征。方法回顾性分析经病理证实的9例HAML的MRI特征及临床表现。结果 9例均为单发肿块,中位直径4.0 cm(1.4~15.3 cm)。7例无不适症状,2例上腹部不适,均行手术切除,中位随访10个月(2~24个月),无复发。组织学上分为混合型4例和肌瘤型5例。免疫组化均HMB-45(+)、SMA(+)、CD34(+)。5例MRI回波序列见大量脂质成分。增强MRI分两种类型:Ⅰ型,动脉期明显强化,门脉期和延迟期仍强化(混合型和肌瘤型各1例),其对应病理为肿瘤组织含较少血管;Ⅱ型,动脉期强化,门脉期和延迟期消退,其病理为肿瘤富含血管(混合型3例及肌瘤型4例)。结论 HAML临床表现无特异性,HAML的增强MRI特征与肿瘤组织富含血管多少有关。确诊需病理及免疫组化检测HMB-45、SMA、CD34阳性。
Objective To investigate the MRI findings and clinicopathological features of hepatic angiomyolipoma (HAML). Methods The MRI features and clinical manifestations of 9 HAML confirmed by pathology were analyzed retrospectively. Results All the 9 cases were single mass with a median diameter of 4.0 cm (1.4-15.3 cm). Seven patients had no symptoms and two patients had upper abdominal discomfort. All patients underwent surgical resection. The patients were followed up for 10 months (2-24 months) with no recurrence. Histologically, there were 4 cases of mixed type and 5 cases of myoma type. Immunohistochemistry HMB-45 (+), SMA (+), CD34 (+). 5 cases of MRI echo sequence to see a large number of lipid components. Enhanced MRI divided into two types: type Ⅰ, arterial phase was significantly enhanced portal phase and delayed phase is still enhanced (mixed and myoma type in 1 case), the corresponding pathological tumor tissue containing fewer vessels; type Ⅱ, artery Intensification, portal phase and delayed phase regression, the pathological tumor is rich in blood vessels (mixed 3 cases and myoma type 4 cases). Conclusion The clinical manifestations of HAML are nonspecific. The features of HAML enhanced MRI are related to the number of tumor vessels rich in blood vessels. Confirmed pathological and immunohistochemical detection of HMB-45, SMA, CD34 positive.