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1、肝局灶性結(jié)節(jié)性增生Focalnodularhyperplasia(FNH)OutlineFNHaccountsforapproximately8%ofallprimaryhepatictumorandisthesecondmostcommonbenignlivertumorafterhemangioma.Thisbenigntumouroccursmostcommonlyinwomenaged20–50years,butmayoccurinbothmenandwomenatanyage,withmultiplelesionsbe
2、ingfoundin20percentofcases.FNHOralcontraceptive口服避孕藥useisassociatedwithFNHbuttheresponsibilityoforalcontraceptivesintheoccurrenceofthelesionhasnotbeendemonstrated.ClinicalsymptomsFNHisusuallyanincidentalfindingatimagingandonlyone-thirdarediscoveredbecauseofclinicalsy
3、mptomssuchasmildepigastricpainordiscomfortandorpalpableabdominalmass.Bloodlivertestsarenormalinhalfofthecasesandshowonlyincreasedinserumgamma-glutamyl-transpeptidase血清r-谷氨酰轉(zhuǎn)肽酶activityinmostoftheremnants.well-circumscribedlobulatedmasswithcentralscar(arrow)andradiatin
4、gseptations.PathologicalappearanceFNHisdefinedasanodulecomposedofbenign-appearinghepatocytesoccurringinaliverthatisotherwisehistologicallynormal.FNHisahyperplasticliverparenchyma(增生性肝實(shí)質(zhì))subdividedintonodulesbyfibrousseptathatmayformstellatescars(星狀瘢痕).Thelesionisusua
5、llysolitary(80%)andmeasureslessthan5cmindiameter.Occasionally,FNHispedunculated(蒂).Photomicrographofhistopathologicspecimenshowsregionsofnodularhepatocellularproliferationseparatedbyradiatingbandsandsurroundingmyxomatousscar(arrows).Themarginissharp,oftenlobulatedand
6、nocapsuleispresent.Hemorrhageandnecrosisarerare.Atmicroscopy,thecentralfibroticzoneisdenseconnectivetissue(致密結(jié)締組織)whichcontainsnumerousabnormallythickwalledarteries.Markedproliferationofbiliarystructuressurroundedbyinflammatorycellsisobservedwithinandattheperiphery(邊
7、緣)ofthefibrousseptae.Kupffercellsarealsoseenwithinthelesion.FNHclassic(80%)non-classic(20%)(a)telangiectaticFNH,(b)withatypia,(c)mixedhyperplasticandadenomatousFNHDiagnosis(CT)NonenhancedCTscansFNHisdemonstratedasafocalhypodenseorisodensemasscomparedwithnormalliver.A
8、centralhypodensescarisdepictedinonlyone-thirdofthecases.Calcificationswithinthecentralscarareveryrareandobservedinonlyabout1%ofthec