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1、 A case of hepatic pseudolymphomaLiu chenhan Department of radiology, Sir Run Run Shaw HospitalCASE:1443371CASE:1443371n nF,64YF,64Y，体检发现肝脏肿物半月余。，体检发现肝脏肿物半月余。n n症状、体征（症状、体征（- -）n n既往：既往：肝肝段血管瘤段血管瘤 n n辅检：辅检：LABLAB肿瘤女肿瘤女-6-6：(2014-08-01),(2014-08-01),癌胚抗原癌胚抗原 CEACEA：5.36ng/ml(0-5ng/ml)5.36ng/ml(0-5ng/
2、ml)；肝酶指标（；肝酶指标（- -）乙肝表面抗原：乙肝表面抗原：117 IU/ml117 IU/ml乙肝核心抗体乙肝核心抗体IgGIgG：13.36 COI 13.36 COI n腹部B超:左肝外叶低弱回声结节，建 议超声造影；n n胃镜：慢性轻度浅表性炎，灶性肠化，幽胃镜：慢性轻度浅表性炎，灶性肠化，幽 门螺杆菌：阴性门螺杆菌：阴性n n肠镜：（肠镜：（- -）eWorldView ImageeWorldView ImagenCT:左肝II段边缘可疑稍低密度灶，请结合 其它检查或复查。nMR:左肝外侧叶占位，恶性病灶不能排除， 转移？或其他。n腹腔镜左肝肿块切除+术中冰冻 n术中未见明显腹
3、水，肝脏无明显结节性改 变，左肝外侧叶可见一大小约2cm肿块，略 突出于肝脏表面，质软，边界尚清，剖开 肿瘤，切面灰黄色，送术中冰冻提示：淋 巴细胞增生，淋巴瘤待排。 n n冰冻送检肝组织一块，冰冻送检肝组织一块， 3.8*3*1.5cm3.8*3*1.5cm，剖面见一灰白结节，剖面见一灰白结节， 1.7*1.5cm1.7*1.5cm，镜示，镜示结节内淋巴组织增生，淋巴滤泡形成，生结节内淋巴组织增生，淋巴滤泡形成，生 发中心可见，大小不等，局部伴小血管增生，结节周围围发中心可见，大小不等，局部伴小血管增生，结节周围围 绕以不连续的纤维组织包膜，包膜局部见淋巴组织浸润，绕以不连续的纤维组织包膜，
4、包膜局部见淋巴组织浸润， 周围肝组织汇管区内亦可见成片淋巴细胞浸润周围肝组织汇管区内亦可见成片淋巴细胞浸润。免疫组化。免疫组化 （B B片）：片）：CD3 HBV surface antigen and HCV antibody were both negativenAFP, CEA, and CA-199 (-)(A) (CT) scans showed a 20-mm- diameter, slightly hypodense mass with peripheral rim enhancement in arterial phase located in segment 2. (B) (
5、B) Early washout of the contrast medium with retained ring enhancement was seen in the portal phase. (C) Axial magnetic resonance (MR) imaging showed a hypointense nodule on segment 2 of the liver in the T1 -weighted image, and (D) the lesion became hyperintense in the T2- weighted image.(E) Arteria
6、l portography with computed tomography demonstrated a perfusion defect in segment 2 of the liver. Angiography showed ahypervascular lesion on segment 6 of the liver (arrow).(F) However, the small tumor in segment 2 of the liver on previous CTand MR had no definite tumor stain.n A hypovascular tumor
7、was impressed,and peripheral type cholangiocarcinoma, metastatic tumor, or sclerosed hemangioma should be differentiated.n A left lateral sectionectomy was performed.Figure 2 Pathological findings of the lesion. Gross pathologic specimen revealed a well-defined, nonencapsulated, yellowish-white, and
8、 soft hepatic tumor, located just beneath the capsule in segment 2 of the liver.nHistopathology of hepatic pseudolymphoma. Hematoxylineeosin-stained histological images showed that the mass was ncomposed of hyperplastic lymphoid tissue with several enlarged, irregularly shaped, well- demarcated foll
9、icles with formation of ngerminal centers distributed evenly in the mass. (A) The lymphocytes containing round nuclei with scant cytoplasm are mainly nsmall in size and mature in appearance with scattered medium and large cells, ?40. Immunohistochemical stain showed that the ngerminal centers were c
10、omposed of B lymphocytes (B) positive to CD20 antibody, ?100, (C) but negative to Bcl-2 (e) antibody, n?100. (D) The interfollicular area was composed of small T lymphocytes positive to CD3 antibody, ?100. (E) Reactive immunoblasts npositive to CD30 antibody were evenly distributed in the interfolli
11、cular region, ?100. (F) However, the EpsteineBarr virus-encoded nRNA stain was negative, ?40.CD20 (+), B cellsBcl-2 (-) B cells CD3 (+) small T cellsReactive CD30 (+) immunoblastsEpsteineBarr virus- encoded RNA(-)nThe patient received regular follow-up, and no recurrence was found during 5 years of
12、follow -up.CASE 2nF,63Y, had a history of PBC and resectionof the left adrenal gland for primary aldosteronism.nShe was asymptomatic on admission and her condition was generally good.nAbdominal ultrasonography showed a hypoechoic lesion,10 mm in diameter in segment 7 .nLaboratory tests(-)A: A hypode
13、nse nodule in plane phase; B: A hyperdense nodule in the early phase after injection of contrast medium; C: A hypodense nodule in the late phase after injection of contrast medium.nhypointense nodule on T1-weighted images;n A hyperintense nodule on T2-weighted images;nA hyperintense nodule in the ea
14、rly phase afterinjection of contrast medium; nA hypointense nodule in the late phase after injection of contrastnmedium.nSuperparamagnetic iron oxide-enhanced MRI showing hyperintense nodules.A: 10 mm nodule in segment 7; B: 4 mm nodule in segment 6.nCT during arterial portography showing hypointens
15、e nodules. A: 10 mm nodule in segment 7; B: 4 mm nodule in segment 6.n Imaging findings suggested HCC, although no other hypervascular tumor could be excluded.n A right posterior segmentectomy was performed.Macroscopically, the lesion in segment 7 was white and hard with clear margins.Microscopically, the lesion consisted of a nodular lymphoid infiltrate with germinal centersnMacroscopically, the lesion in segment 7 was white and hard with clear margins. nMicroscopically,the lesion consisted of a nodular lymphoid infiltrate with germinal centers nIn situ hybridization revealed no significan
