《假性淋巴瘤肝脏》PPT课件

Acaseofhepaticpseudolymphoma,LiuchenhanDepartmentofradiology,SirRunRunShawHospital,CASE:1443371,F,64Y，体检发现肝脏肿物半月余。症状、体征（-）既往：肝段血管瘤辅检：LAB肿瘤女-6：(2014-08-01),癌胚抗原CEA：5.36ng/ml(0-5ng/ml)；肝酶指标（-）乙肝表面抗原：117IU/ml乙肝核心抗体IgG：13.36COI,腹部B超:左肝外叶低弱回声结节，建议超声造影；胃镜：慢性轻度浅表性炎，灶性肠化，幽门螺杆菌：阴性肠镜：（-）,eWorldViewImage,eWorldViewImage,CT:左肝II段边缘可疑稍低密度灶，请结合其它检查或复查。MR:左肝外侧叶占位，恶性病灶不能排除，转移？或其他。,腹腔镜左肝肿块切除+术中冰冻术中未见明显腹水，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。,冰冻送检肝组织一块，3.8*3*1.5cm，剖面见一灰白结节，1.7*1.5cm，镜示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，结节周围围绕以不连续的纤维组织包膜，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。免疫组化（B片）：CD3HBVsurfaceantigenandHCVantibodywerebothnegativeAFP,CEA,andCA-199(-),(CT)scansshoweda20-mm-diameter,slightlyhypodensemasswithperipheralrimenhancementinarterialphaselocatedinsegment2.(B)Earlywashoutofthecontrastmediumwithretainedringenhancementwasseenintheportalphase.(C)Axialmagneticresonance(MR)imagingshowedahypointensenoduleonsegment2oftheliverintheT1-weightedimage,and(D)thelesionbecamehyperintenseintheT2-weightedimage.(E)Arterialportographywithcomputedtomographydemonstratedaperfusiondefectinsegment2oftheliver.Angiographyshowedahypervascularlesiononsegment6oftheliver(arrow).(F)However,thesmalltumorinsegment2oftheliveronpreviousCTandMRhadnodefinitetumorstain.,Ahypovasculartumorwasimpressed,andperipheraltypecholangiocarcinoma,metastatictumor,orsclerosedhemangiomashouldbedifferentiated.Aleftlateralsectionectomywasperformed.,Figure2Pathologicalfindingsofthelesion.Grosspathologicspecimenrevealedawell-defined,nonencapsulated,yellowish-white,andsofthepatictumor,locatedjustbeneaththecapsuleinsegment2oftheliver.,Histopathologyofhepaticpseudolymphoma.Hematoxylineeosin-stainedhistologicalimagesshowedthatthemasswascomposedofhyperplasticlymphoidtissuewithseveralenlarged,irregularlyshaped,well-demarcatedfollicleswithformationofgerminalcentersdistributedevenlyinthemass.(A)Thelymphocytescontainingroundnucleiwithscantcytoplasmaremainlysmallinsizeandmatureinappearancewithscatteredmediumandlargecells,?40.ImmunohistochemicalstainshowedthatthegerminalcenterswerecomposedofBlymphocytes(B)positivetoCD20antibody,?100,(C)butnegativetoBcl-2(e)antibody,?100.(D)TheinterfollicularareawascomposedofsmallTlymphocytespositivetoCD3antibody,?100.(E)ReactiveimmunoblastspositivetoCD30antibodywereevenlydistributedintheinterfollicularregion,?100.(F)However,theEpsteineBarrvirus-encodedRNAstainwasnegative,?40.,CD20(+),Bcells,Bcl-2(-)Bcells,CD3(+)smallTcells,ReactiveCD30(+)immunoblasts,EpsteineBarrvirus-encodedRNA(-),Thepatientreceivedregularfollow-up,andnorecurrencewasfoundduring5yearsoffollow-up.,CASE2,F,63Y,hadahistoryofPBCandresectionoftheleftadrenalglandforprimaryaldosteronism.Shewasasymptomaticonadmissionandherconditionwasgenerallygood.Abdominalultrasonographyshowedahypoechoiclesion,10mmindiameterinsegment7.Laboratorytests(-),A:Ahypodensenoduleinplanephase;B:Ahyperdensenoduleintheearlyphaseafterinjectionofcontrastmedium;C:Ahypodensenoduleinthelatephaseafterinjectionofcontrastmedium.,hypointensenoduleonT1-weightedimages;AhyperintensenoduleonT2-weightedimages;Ahyperintensenoduleintheearlyphaseafterinjectionofcontrastmedium;Ahypointensenoduleinthelatephaseafterinjectionofcontrastmedium.,Superparamagneticironoxide-enhancedMRIshowinghyperintensenodules.A:10mmnoduleinsegment7;B:4mmnoduleinsegment6.CTduringarterialportographyshowinghypointensenodules.A:10mmnoduleinsegment7;B:4mmnoduleinsegment6.,ImagingfindingssuggestedHCC,althoughnootherhypervasculartumorcouldbeexcluded.Arightposteriorsegmentectomywasperformed.,Macroscopically,thelesioninsegment7waswhiteandhardwithclearmargins.,Microscopically,thelesionconsistedofanodularlymphoidinfiltratewithgerminalcenters,Macroscopically,thelesioninsegment7waswhiteandhardwithclearmargins.Microscopically,thelesionconsistedofanodularlymphoidinfiltratewithgerminalcentersInsituhybridizationrevealednosignificantdifferencebetweenthenumbersofcellspositiveforkappa-chainandlambda-chain,CD3(+)T-cells,CD20(+)B-cells,Stainedforlightchains,Stainedforlightchains,Thepatienthadanuneventfulpostoperativecourseandhasshownnosignofrecurrencefor11M.,Summary,HPLshouldbeconsideredinthedifferentialdiagnosisofsmall