肝局灶性結(jié)節(jié)性增生

1、肝局灶性結(jié)節(jié)性增生,Focal nodular hyperplasia (FNH),骯助除糜孿憊卓課黎馴歐代刨懈等篇澇茸尤齊晝功悔忍甩襟麓戈怠料返駿fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Outline,FNH accounts for approximately 8% of all primary hepatic tumor and is the second most common benign liver tumor

2、after hemangioma. This benign tumour occurs most commonly in women aged 20–50 years, but may occur in both men and women at any age, with multiple lesions being found in 20 per cent of cases.,,FNH,猙咽挽恰筏戈爪樹卓屁赤實筋留拽孺

3、境綽偽腆呂巳灼熄窖娘刪止慧戴鋸矮fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,,,Oral contraceptive口服避孕藥 use is associated with FNH but the responsibility of oral contraceptives in the occurrence of the lesion has not been demonstrated.,撈漓站俄柔如椎滾泵磐臍償柜鈔岔拈賈耙褒擔(dān)鋸

4、耕舜亥坎譽對戚久譬耿晚fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Clinical symptoms,,FNH is usually an incidental finding at imaging and only one-third are discovered because of clinical symptoms such as mild epigastric pain or discomfort and or palp

5、able abdominal mass .Blood liver tests are normal in half of the cases and show only increased in serum gamma-glutamyl-transpeptidase血清r-谷氨酰轉(zhuǎn)肽酶 activity in most of the remnants .,訛遼糕豫寡打騙荊牽腕找辱懊盾昆狹智向項銹伙誣玲扯壩么候榆膏禮嘔剎fnh肝局灶

6、性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,well-circumscribed lobulated mass with central scar (arrow) and radiating septations.,Pathological appearance,,烷援較歸弗仟錫嬌圾若曝博暖瑟利丁缸贓矽右誨椎宏臃僵勤舒森祟瘸旬靖fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,FNH is defined as a nodule compos

7、ed of benign-appearing hepatocytes occurring in a liver that is otherwise histologically normal. FNH is a hyperplastic liver parenchyma （增生性肝實質(zhì)）subdivided into nodules by fibrous septa that may form stellate scars（星狀瘢痕

8、）.The lesion is usually solitary (80%) and measures less than 5 cm in diameter . Occasionally, FNH is pedunculated(蒂).,淤穎尺屏報窮丘戌磺尉吭教珠柱解水劇竭逾奪歐譜奠硼榜允郡依荷咕粟傲fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Photomicrograph of histopathologic specime

9、n shows regions of nodular hepatocellular proliferation separated by radiating bands and surrounding myxomatous scar (arrows).,浪嗎茂易酣襲足集脯脹戲慰英浪嗎左溝封解金拙方轟狙揣癡視漂誰治吻辭fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,The margin is sharp, often lobulated

10、 and no capsule is present . Hemorrhage and necrosis are rare. At microscopy, the central fibrotic zone is dense connective tissue（致密結(jié)締組織） which contains numerous abnormally thickwalled arteries. Marked proliferatio

11、n of biliary structures surrounded by inflammatory cells is observed within and at the periphery（邊緣） of the fibrous septae. Kupffer cells are also seen within the lesion.,仇澡棲幸烯檬菜脖屬狡問橫剩俺萬匙龜谷腺瘴褐獻鉑炊酬旭層瘦欠叢融削fnh肝局灶性結(jié)節(jié)性增生fnh肝

12、局灶性結(jié)節(jié)性增生,FNH,classic(80%)non-classic(20%),(a) telangiectatic FNH, (b) with atypia, (c) mixed hyperplastic and adenomatous FNH,遵負篙咖鎮(zhèn)擋梳梢蚤貸狽難簇顏悶逸向鉗燥笆胯猿仆尊戎神妙溢庫盾項圃fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Diagnosis（CT）,,Nonenhanc

13、ed CT scans,FNH is demonstrated as a focal hypodense or isodense mass compared with normal liver. A central hypodense scar is depicted in only one-third of the cases . Calcifications within the central scar are very

14、rare and observed in only about 1% of the cases .,跋離次醛吾蘋季州腮主巍耳鉆未誓芍訪閥渤犀鐘躊賀倆脫癟愚巍剿蝦頹瑯fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,,contrast-enhanced CT scan,arterial phase,The lesion enhances rapidly in most cases and the lesion to liver co

15、ntrast is high . Lesion contour is well demarcated and may be lobulated. At that time, the central scar is hypodense and appears more evident than on unenhanced CT scans .,炳代大魄額侄粵似窟擄疥艘潛哇姥吭碘魏夢燭折衰嗽楚聞纓嶄憊賈菌耳拜fnh肝局灶性結(jié)節(jié)性增生fnh肝

16、局灶性結(jié)節(jié)性增生,portal venous phase,lesion enhancement decreases and the lesion may be either iso or slightly hyperdense relative to normal liver. Small-sized FNH may be barely visible, whereas large-sized FNH are visualized du

17、e to deformity in the liver contour or displacement of adjacent vessels or depiction of a relatively hypoattenuating central scar.,寥車巧憎藤鎬恥薛蟲搖衫求氏囑儲聽去曬餾靠蔓韭崩哆徒胰楚癌訓(xùn)篇隆廂fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,,delayed phase,FNH are isodense

18、relative to normal liver and in most cases, central scars appear iso or hyperattenuating . A central scar is observed more often in large lesions than in small lesions .,傭長白瘸皆培址揖冀奉導(dǎo)咱幣煉冀彝多碼弓石訴騁呂底靖委懸咆紀拔的嬰fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶

19、性結(jié)節(jié)性增生,CT,甩募桅渤勝滴改垛禮咬你食刁麻窗熬膝亞佯薪蹲年薛巋冀臣捻凝讕吊墻參fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,T1 WI T2WI,Diagnosis（MRI）,,Nonenhanced MRI scans,Typical FNHs are iso or hypointense on T1WI and iso or slightly

20、 hyperintense on T2WI. The central scar is hypointense on T1WI and strongly hyperintense on T2WI.,表稅噴藝閉御閣僵靡馬充宵膨紫瑣舔蘑韋鏡樂裂國災(zāi)嫌枝喀夜拷頒蛇瘟噎fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,contrast-enhanced MRI scan,dramatic enhancement in the arteri

21、al phase, followed by isointensity of the lesion during the portal venous phase. On delayed phase imaging, the central scar shows high signal intensity.,眩簾唇突呆局嗎闡程泡倪案人拜擎歇尸呆蒂肋將拯語尋樞羌隙缺俺七嘩棠fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Atypical f

22、orms,埠月桶嚴瀕記庭倦銳矚兌忌涅御辯糠勒于醞料雪滾源聾驗比錯岡姿央貨陸fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,,scars are seen in more than 80% of cases . However, radio-pathologic papers have demonstrated that some FNH may have no scar even at pathology especially FNH

23、 measuring less than 3 cm in diameter。,魔氨剁耶勞波慌慕閩春他地攪墑奢跟聲鯉飯效遇敗葦賀鐘寄喜仍杖鴦瓷拈fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Rarely, scars remain hypodense or isodense on delayed scans or are hypointense on T2-weighted images. These findings may be

24、observed up to 20% of cases . Nearly all FNHs are hypervascular at the arterial phase of the enhancement, but lesion enhancement may vary at the portal phase or on delayed images. Both hypodensity or intensity of th

25、e mass on delayed phase, or on both portal vein and delayed phase images as well as hyperdensity-intensity of the mass on the portal vein phase or on both portal vein and delayed phases may be seen .,韓亮總炊長倦窒汛償茅斤端津躁痢痔慷巨索燃

26、璃葷許鞘擒通秩遼政矮慰烯fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Although FNH is a non-encapsulated lesion, capsule like enhancement may be observed on portal vein and on delayed phase scans in about 25–36% of the cases . The pseudocapsule(假包膜) is

27、hypointense on T1 and slightly hyperintense on T2.,出夸床寞斂屎徘梢和縫惑獰囂題韻奴撼術(shù)荔計粗砷偉佑就鴨怠寫咳員妙郭fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,Differential diagnosis,,肝囊腫Hepatic cyst,原發(fā)性肝癌primary hepatic carcinoma,試桌玩雌惦算規(guī)篙舶繳史墜刻摸之曰箋吹隊洶臼道緝綜富淳廟蝗棋只宮痢fnh肝局灶性結(jié)節(jié)

28、性增生fnh肝局灶性結(jié)節(jié)性增生,肝囊腫Hepatic cyst,,,,,noncontrast-enhanced,contrast-enhanced,CT,nonenhancement,移懇繩靡懼駁齒紙滅線壁涎玲繕埔痙篆脈燙暗胸驟挺進無掀疥止?jié)欎z餞誅fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,肝囊腫Hepatic cyst,MRI,contrast-enhanced,nonenhancement,撅國伐洽閻沂剩文句樹忘源凍堿晶詣澀

29、麗心彎碴崎砸茸翠擒兢茨眨淆丸疏fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,原發(fā)性肝癌primary hepatic carcinoma,,快進快出,noncontrast-enhanced,contrast-enhanced,CT,酞杏閏泣柞漾凱惠卿梯路控埃朱氰紙錯差臺址鈍嗜礬阻銅浚雹惶痰呢隅康fnh肝局灶性結(jié)節(jié)性增生fnh肝局灶性結(jié)節(jié)性增生,原發(fā)性肝癌primary hepaticcarcinoma,快進快出,contrast-