目的报告8例肝血管平滑肌脂肪瘤的影像学特征及病理学特点，探讨其诊断与治疗方法。方法对8例经手术及病理证实的肝血管平滑肌脂肪瘤的术前影像学表现（B超、CT、MRI、99mTcPMT）、手术情况及病理特点进行分析。结果B超： 肿瘤呈强回声光团6例，低回声光团2例； 边界清楚7例，血供丰富、内部回声不均匀4例，其中1例内部呈分隔网状结构。彩色Doppler超声示肿瘤血供丰富，均测及动脉频谱，阻力指数为0.4～0.5。静脉造影示肿瘤内血流信号明显增加。CT： 平扫示肿瘤呈低密度影7例，不均匀5例，边界清楚7例，肿瘤内见软组织影2例，脂肪成分2例。增强扫描示动脉期明显强化，门脉期及延迟期逐渐呈低密度。MRI: 肿瘤呈短T1、长T2信号，增强后强化明显，脂肪抑制后短T1变成长T1。99mTcPMT示肿瘤呈放射性增强，5 min相肿块区呈放射性缺损，2 h、5 h延迟相肿块区未见放射性填充，肝血池相肿块呈放射性填充。病理及免疫组化： 肿瘤由成熟的脂肪、血管及平滑肌组成，HMB45阳性。术前确诊3例。结论B超示强回声光团，CT呈低密度影中出现软组织影、脂肪成分，增强明显，MRI出现脂肪信号，脂肪抑制后短T1变成长T1，增强明显。99mTcPMT示肿瘤呈放射性增强，5 min相呈放射性缺损，延迟相未见放射性填充，肝血池相呈放射性填充。这些是肝血管平滑肌脂肪瘤的影像学特点，结合病史可作出诊断。此病应尽早手术治疗，行肝部分切除术。最后确诊依靠病理检查及免疫组化分析。
Objective?To evaluate the value of various CT features in differentiating renal angiomyolipoma (RAML) with minimal fat and renal cell carcinoma (RCC). Methods?The Cochrane Library, PubMed, MEDLINE (OVID), EMBase, and the Chinese Periodical Wed (CNKI, CBM, VIP) were searched. They were searched from Jan 2001 to Nov 2008. Trials screening, quality assessment, and data extraction was conducted according to the inclusion criteria recommended by the Cochrane Collaboration. The SROC curve and meta-analyses were performed by Meta-disc 1.4. Results?Seven trials, involving 482 patients and 513 tumors, were included. The studies were highly homogonous. It was considered that 8 features including single or multiple lesions, scanning density, calcification, angle with cortex, levering-cortex-up sign, lesions pro-trusion, homogeneous enhancement, and prolonged enhancement, played certain roles in differentiating RAML with minimal fat and RCC. Among these features, interface with the cortex was the most important, and the features of homogeneous enhancement and prolonged enhancement were the second most important. Conclusion?Besides measuring lipoid tissue in the tumor, there are another 8 features which are valuable to the differentiation of RAML with minimal fat and RCC.
【摘要】 目的 探讨颈部对称性脂肪瘤的诊断和治疗。 方法 对2004年3月-2010年10月收治的5例颈项部脂肪瘤患者，其临床症状、体征、术前术后处理及结果等临床资料进行回顾。 结果 5例均为男性，以颈、项部大量皮下脂肪堆积为主要临床表现，其中1例伴有胸部上分皮下脂肪堆积，呈对称性隆起。3例患者伴阻塞性睡眠呼吸暂停低通气综合征，2例患者有睡眠打鼾但无明显呼吸暂停。4例患者有脂肪肝和长期酗酒史，但肝功能无异常改变，其中1例（1/4）有多次乙醇中毒史。1例患者无酗酒史，但诉经常作颈部刮痧治疗。5例均行外科手术切除，术中见肿瘤为白色无包膜脂肪组织。术后随访3个月~2年，1例术后1年复发，未行再次治疗，其余未见明显复发。 结论 颈部对称性脂肪瘤是脂肪组织弥漫性、对称性沉积于颈胸部皮下浅筋膜间隙和（或）深筋膜间隙的良性疾病。患者以中年男性居多，长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助，但酗酒可能并非唯一病因。对于影响美观及功能的患者，其手术疗效较理想。【Abstract】 Objective To explore the diagnosis and treatment of symmetric lipomatosis in the neck. Methods We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010. Results All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group. Conclusions Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.
【摘要】 目的 探讨肝脏血管平滑肌脂肪瘤（hepatic angiomyolipoma，HAML）的多层螺旋CT影像学表现特征及其与病理学基础的相关性，以进一步提高CT诊断的准确性。 方法 收集2008年11月-2010年12月经手术病理证实的16例HAML患者。所有患者均行螺旋CT平扫及动脉期、门脉期增强检查，重点观察HAML的分型及其相应CT表现及影像-病理的相关性。 结果 16例患者共20个病灶，19个为稍低密度病灶，其中11个病灶内可见明显的脂肪密度影；1个为稍高密度病灶。动脉期所有病灶均有不同程度的强化表现，15个病灶内可见到较明显条状及扭曲的血管影。门脉期15个病灶有持续强化。 结论 多层螺旋CT能准确反映HAML的分型及其病理特征，对临床表现不典型患者的诊断和鉴别诊断有较大诊断价值。【Abstract】 Objective To discuss the correlation between the features of multislice spiral CT results for hepatic angiomyolipoma (HAML) and their pathological basis, and to further improve the diagnostic accuracy through CT examination. Methods Sixteen HAML patients diagnosed pathologically between November 2008 and December 2010 in our hospital were enrolled in our study. All patients underwent multi-slice spiral CT scanning of pre-and post-contrast arterial phase, and portal venous phase. Focus was put on observation of HAML types and their corresponding manifestations, and the correlation between CT imaging and the pathologic basis. Results There were 20 lesions in the 16 patients. Among the 19 hypodense lesions, 11 were clearly seen with fat density shadow. One out of the 20 lesions showed as slightly hyperdense. On the arterial phase scanning, all lesions showed enhancement, and obvious vascular shadow could be seen in15 lesions. On the portal venous phase, 15 lesions continued to strengthen. Conclusions Multi-slice spiral CT can accurately reflect the classification of HAML and its pathological features. It has a great value in the diagnosis and differential diagnosis of patients without typical clinical manifestations.
【摘要】 目的 探讨肾上腺髓样脂肪瘤的彩色多普勒超声表现和超声诊断价值。 方法 回顾性分析2005年3月-2010年9月58例61个经手术及病理证实的肾上腺髓脂肪瘤病灶的彩色多普勒超声表现，对病变的大小、内部回声特点及血流特点进行分析。 结果 在2005年3月-2007年12月的28个病灶超声诊断出肾上腺病变23个，正确率82.1%；诊断为髓脂肪瘤2个，正确率7.1%；漏诊1个，误诊4个。2008年1月-2010年9月，33个病灶超声诊断出肾上腺病变30个，正确率90.9%；诊断为髓脂肪瘤19个，正确率57.6%；无漏诊，误诊3个。52个病灶超声表现为边界清晰，形态基本规则，内部呈均匀中等强回声（与肾集合系统回声相当），内部未测及血流信号， 另8个病灶表现为中等强回声与低回声相间。 结论 肾上腺髓样脂肪瘤具有特征性的彩色多普勒超声声像图表现， 可用于发现病变并对多数肾上腺髓样脂肪瘤做出定性诊断。【Abstract】 Objective To evaluate the value of sonographic diagnosis of adrenal myelolipoma. Methods Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed. Results In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected. Conclusion Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.
:目的:探讨肾上腺髓样脂肪瘤的临床、影像学及病理特点。方法:回顾性分析28例肾上腺髓样脂肪瘤患者的临床资料,结合文献分析其特点。结果:28例患者肿瘤均经手术切除,并经病理检查证实为肾上腺髓样脂肪瘤,随访至今未见复发。结论:肾上腺髓样脂肪瘤的诊断主要依靠B超、CT和MRI,术前诊断困难,确诊需经病理学检查,手术切除是有效的治疗方法。
Objective To investigate the CT imaging features of hepatic angiomyolipoma and its clinical characteristics. Methods The clinical, radiological, and pathological data of 3 hepatic angiomyolipoma (HAML) patients were retrospectively collected, and the imaging and diagnostic features were analyzed.Results All 3 cases were females, 2 complained of abdominal pain and one was absent of symptom. Both the laboratory examinations were normal in 2 cases, and hepatitis B virus markers were positive in one case. For CT features, the mass located in the superior anterior segment of the right hepatic lobe, in the posterior inferior segment of the right hepatic lobe, and in the left medial lobe, respectively. There were components of fat and soft tissue attenuation in these masses, and in which the CT value of the fat component was from -80 HU to -20 HU (mean -50 HU). There were enhancement in different degree and enhanced vascular imaging could be seen within the lesions. During surgery, all 3 masses were outgrowed from the hepatic lobes. Immunostainning showed HMB45 (+), αSMA (+), S100 (+)，which were bly suggestive of HAML.Conclusion HAML is a rare benign tumor with characteristic CT appearance, and its definite diagnosis relies on the immunohistochemical staining of HMB-45.
【摘要】目的探讨肝血管平滑肌脂肪瘤的临床病理特点、诊断及鉴别诊断。 方法对3例肝血管平滑肌脂肪瘤患者有关病理检查结果进行回顾性分析。 结果肿瘤位于肝右叶2例，肝左叶1例。肿瘤直径为2～10 cm，平均6.2 cm。3例肿瘤内均见平滑肌、脂肪、畸形厚壁血管，但未见髓外造血灶。对黑色素瘤（HMB45）、结合蛋白（desmin)及肌动蛋白（actin)检查均呈阳性反应。术后随访6～36个月，未见肿瘤复发。结论肝血管平滑肌脂肪瘤由3种成分组成，病理形态变化多样，必须与多种肝肿瘤相鉴别。平滑肌细胞HMB45表达呈强阳性反应是诊断肝血管平滑肌脂肪瘤较可靠的依据。