fnh肝局灶性結(jié)節(jié)性增生課件

1、肝局灶性結(jié)節(jié)性增生Focal nodular hyperplasia (FNH) fnh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 hyperplOutline FNH accounts for approximately 8% of all primary hepatic tumor and is the second most common benign liver tumor after hemangioma. This benign tumour occurs most commonly in women aged 2050 years, but may occu

2、r in both men and women at any age, with multiple lesions being found in 20 per cent of cases.FNH fnh肝局灶性結(jié)節(jié)性增生2OutlineFNH fnh肝局灶性結(jié)節(jié)性增生2 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. fnh肝局灶性結(jié)

3、節(jié)性增生3 Oral contraceptive口服避孕藥 use Clinical symptomsFNH 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 palpable abdominal mass .Blood liver tests are normal in half of the cases and show only

4、 increased in serum gamma-glutamyl-transpeptidase血清r-谷氨酰轉(zhuǎn)肽酶 activity in most of the remnants .fnh肝局灶性結(jié)節(jié)性增生4Clinical symptomsFNH is usuall well-circumscribed lobulated mass with central scar (arrow) and radiating septations. Pathological appearancefnh肝局灶性結(jié)節(jié)性增生5 well-circumscribed lobulated FNH is def

5、ined as a nodule composed of benign-appearing hepatocytes occurring in a liver that is otherwise histologically normal. FNH is a hyperplastic liver parenchyma （增生性肝實(shí)質(zhì)）subdivided into nodules by fibrous septa that may form stellate scars（星狀瘢痕）.The lesion is usually solitary (80%) and measures less th

6、an 5 cm in diameter . Occasionally, FNH is pedunculated(蒂). fnh肝局灶性結(jié)節(jié)性增生6FNH is defined as a nodule comPhotomicrograph of histopathologic specimen shows regions of nodular hepatocellular proliferation separated by radiating bands and surrounding myxomatous scar (arrows).fnh肝局灶性結(jié)節(jié)性增生7Photomicrograph

7、of histopatholThe margin is sharp, often lobulated 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 proliferation of biliary structures surrounded

8、by inflammatory cells is observed within and at the periphery（邊緣） of the fibrous septae. Kupffer cells are also seen within the lesion. fnh肝局灶性結(jié)節(jié)性增生8The margin is sharp, often lobFNH classic(80%)non-classic(20%) (a) telangiectatic FNH, (b) with atypia, (c) mixed hyperplastic and adenomatous FNH fnh肝

9、局灶性結(jié)節(jié)性增生9FNH fnh肝局灶性結(jié)節(jié)性增生9Diagnosis（CT）Nonenhanced 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 rare and observed in only about 1% o

10、f the cases .fnh肝局灶性結(jié)節(jié)性增生10Diagnosis（CT）Nonenhanced Fcontrast-enhanced CT scanarterial phaseThe lesion enhances rapidly in most cases and the lesion to liver contrast is high . Lesion contour is well demarcated and may be lobulated. At that time, the central scar is hypodense and appears more eviden

11、t than on unenhanced CT scans .fnh肝局灶性結(jié)節(jié)性增生11contrast-enhanced CT scanarter portal venous phaselesion 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 due to deformity

12、 in the liver contour or displacement of adjacent vessels or depiction of a relatively hypoattenuating central scar. fnh肝局灶性結(jié)節(jié)性增生12 portal venous phaselesion enh delayed phase FNH are isodense relative to normal liver and in most cases, central scars appear iso or hyperattenuating . A central scar i

13、s observed more often in large lesions than in small lesions .fnh肝局灶性結(jié)節(jié)性增生13 delayed phase FNH are isodeCTfnh肝局灶性結(jié)節(jié)性增生14CTfnh肝局灶性結(jié)節(jié)性增生14T1 WI T2WI Diagnosis（MRI）Nonenhanced MRI scans Typical FNHs are iso or hypointense on T1WI and iso or slightly hyperintense on T2WI. The central scar is hypointense

14、 on T1WI and strongly hyperintense on T2WI.fnh肝局灶性結(jié)節(jié)性增生15T1 WI contrast-enhanced MRI scan dramatic enhancement in the arterial phase, followed by isointensity of the lesion during the portal venous phase. On delayed phase imaging, the central scar shows high signal intensity. fnh肝局灶性結(jié)節(jié)性增生16contrast-

15、enhanced MRI scan Atypical formsfnh肝局灶性結(jié)節(jié)性增生17Atypical formsfnh肝局灶性結(jié)節(jié)性增生17scars 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 measuring less than 3 cm in diameter。 fnh肝局灶性結(jié)節(jié)性增生18scars are seen i

16、n more than 80 Rarely, scars remain hypodense or isodense on delayed scans or are hypointense on T2-weighted images. These findings may be 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

17、on delayed images. Both hypodensity or intensity of the 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 . fnh肝局灶性結(jié)節(jié)性增生19 Rarely, scars remain hypode Alt

18、hough FNH is a non-encapsulated lesion, capsule like enhancement may be observed on portal vein and on delayed phase scans in about 2536% of the cases . The pseudocapsule(假包膜) is hypointense on T1 and slightly hyperintense on T2.fnh肝局灶性結(jié)節(jié)性增生20 Although FNH is a non-encap Differential diagnosis肝囊腫Hepatic cyst 原發(fā)性肝癌primary hepatic carcinomafnh肝局灶性結(jié)節(jié)性增生21 Differential diagnosis肝囊腫Hep肝囊腫Hepatic cystnoncontrast-enhancedcontrast-enhancedCTnonenhancementfnh肝局灶性結(jié)節(jié)性增生22肝囊腫Hepatic cystnoncontrast-enh肝囊腫Hepatic cystT1WIT2WIMRIcontrast-enhancednonenhancementfnh肝局灶性結(jié)節(jié)性