CAJ | 학술논문

目的：探讨肝脏原发性腺鳞癌(ASC)的临床特点及 CT 影像表现，提高对本病的认识，减少误诊。方法回顾性分析经手术病理证实的7例肝脏原发性 ASC 的临床资料及 CT 影像表现。结果所有患者均表现为上腹部隐痛、发热伴畏寒、寒战，既往均有长期胆管炎、胆管结石病史，无乙肝、肝硬化，实验室检查指标甲胎蛋白(AFP)均正常。7例病灶均单发，肝左叶4例，右叶3例。CT 平扫均表现为低密度肿块，边缘模糊，密度不均，内见多发不规则的更低密度区。动脉期均呈轻度不均匀环状强化，静脉期持续环状强化，肿块内分隔厚薄不均，呈蜂窝状，内缘凹凸不平，见强化的结节状突起，中央见大小不等的低密度坏死区，延迟期进一步环状强化，结节状突起明显强化，低密度坏死区始终无强化。肿块周围及肝内胆管扩张、积气，合并胆总管、肝内胆管结石5例。结论肝脏原发性 ASC 具有一定临床特点。老年患者肝内病灶呈渐进性、持续性不均匀环状强化及延迟强化，分隔厚薄不均呈蜂窝状，内缘凸凹不平，见强化的结节状突起，应考虑到此肿瘤的可能。
목적：탐토간장원발성선린암(ASC)적림상특점급 CT 영상표현，제고대본병적인식，감소오진。방법회고성분석경수술병리증실적7례간장원발성 ASC 적림상자료급 CT 영상표현。결과소유환자균표현위상복부은통、발열반외한、한전，기왕균유장기담관염、담관결석병사，무을간、간경화，실험실검사지표갑태단백(AFP)균정상。7례병조균단발，간좌협4례，우협3례。CT 평소균표현위저밀도종괴，변연모호，밀도불균，내견다발불규칙적경저밀도구。동맥기균정경도불균균배상강화，정맥기지속배상강화，종괴내분격후박불균，정봉와상，내연요철불평，견강화적결절상돌기，중앙견대소불등적저밀도배사구，연지기진일보배상강화，결절상돌기명현강화，저밀도배사구시종무강화。종괴주위급간내담관확장、적기，합병담총관、간내담관결석5례。결론간장원발성 ASC 구유일정림상특점。노년환자간내병조정점진성、지속성불균균배상강화급연지강화，분격후박불균정봉와상，내연철요불평，견강화적결절상돌기，응고필도차종류적가능。
Objective To investigate the clinical features and CT appearances of primary adenosquamous carcinoma (ASC)of the liver and to improve the understanding of this disease for the sake of misdiagnosis.Methods The clinical features and CT appearances in 7 patients proved by operation and pathology were reviewed,retrospectively.Results All of the patients had dull pain in upper abdo-men,fever,chills and a long history of cholangitis and biliary calculi.In addition,all patients had not the history of hepatitis B and liver cirrhosis.And the serum AFP level was normal.The single lesion was found in every patient including 4 lesions in the left lobe of liver and the other 3 in the right lobe.Plain CT showed all masses with hypodensity,heterogeneity and unclear edge in liver,and multiple irregular and more hypodense areas in lesions were found.Slight heterogeneous honeycomb-like enhancement in the arterial phase was showed.In the venous phase,persistent honeycomb-like enhancement with uneven separations,nodular bulge and hypo-dense necrotic area was found.In the delayed phase,further honeycomb-like enhancement with hypodense necrotic area and obvious-ly enhanced nodular bulge was showed.The bile ducts in the liver and around the mass were dilated and had pneumatosis in company with lithiasis in choledochus and intrahepatic bile duct in 5 patients.Conclusion Primary hepatic ASC has certain clinical character-istics in older patients.The CT characteristic features included:honeycomb-like lesions with persistent,heterogeneous,delayed en-hancement and heterogeneous separation,uneven inner edge and enhanced nodular bulge.