肝脏疾病本科

1、会计学1肝脏疾病本科肝脏疾病本科第1页/共108页第2页/共108页31: liver; 2: rib cage; 3: spine; 4: pelvis 第3页/共108页4第4页/共108页5第5页/共108页64-Cauinaud segmentation第6页/共108页75-left hepatic vein第7页/共108页86-middle hepatic vein第8页/共108页97- hepatic vein & portal vein第9页/共108页108- portal vein plane第10页/共108页11第11页/共108页12第12页/共108页1

2、39- circulation第13页/共108页14第14页/共108页第15页/共108页16第16页/共108页17第17页/共108页18第18页/共108页19Hepatic trauma -imaging findingsHydrops at the adrenal glandHepatic trauma with fracture of left rib第19页/共108页20J. David Richardson, et al. ANNALS OF SURGERY, 232( 3): 324330.第20页/共108页21第21页/共108页22第22页/共108页23第23页

3、/共108页24第24页/共108页第25页/共108页26第26页/共108页27第27页/共108页28第28页/共108页29第29页/共108页3020/100,00040/100,000NPCHCC第30页/共108页31中国是中国是HCCHCC高发地区高发地区Global Cancer Statistics, 2002. CA Cancer J Clin 2005;55;74-108n20022002年全球新发病例年全球新发病例 626,162626,162n中国病例占中国病例占5555，约，约344,000344,000n男性高发于女性男性高发于女性 (2.67 : (2.67

4、: 1)1)第31页/共108页32第32页/共108页33第33页/共108页34第34页/共108页35第35页/共108页36第36页/共108页37The satellite nodules of this hepatocellular carcinoma represent either intrahepatic spread of the tumor or multicentric origin of the tumor. 第37页/共108页38第38页/共108页39Coarse lamellar fibrosis is characteristic histologicall

5、y; note the pale body in the large eosinophilic malignant hepatocyte (X40). 第39页/共108页40This HCC is composed of liver cords that are much wider than the normal liver plate that is two cells thick. There is no discernable normal lobular architecture, though vascular structures are present. 第40页/共108页

6、41n早期无明显症状：早期无明显症状：即亚临床肝癌（无症状和体征）n肝区疼痛肝区疼痛：常见的首发症状，持续性钝痛、刺痛、胀痛；可伴牵涉痛n肝肿大肝肿大：中、晚期肝癌常见n消化道症状：消化道症状：腹胀、食欲减退、恶心呕吐、腹泻、出血n全身症状：全身症状：乏力、消瘦、低热n晚期肝癌症状：晚期肝癌症状：贫血、黄疸、腹水、浮肿、恶液质n癌肿转移部位的相应症状：癌肿转移部位的相应症状：肺、骨、脑n伴癌综合症伴癌综合症：低血糖症、红细胞增多症、女性男性化 第41页/共108页42第42页/共108页43第43页/共108页44第44页/共108页45n介入后第45页/共108页46HCC-Imaging

7、findingsCT scan Arterial phase Portal vein phase第46页/共108页47第47页/共108页48第48页/共108页49The presence of macrotrabecular architecture in this fragmented area allowed for establishing the diagnosis of HCC (X40). 第49页/共108页50第50页/共108页51第51页/共108页52极早期极早期 (0)PS 0, CPA早期早期(A)PS 0, CPA-B中期中期(B)PS 0, CPA-B晚期晚

8、期(C)PS 1-2, CPA-B终末期终末期(D)PS 2, CPCHCC随机对照试验（随机对照试验（50%）中位生存时间中位生存时间11-20月月 对症对症(20%)生存期生存期3月月HCCHCC BCLC staging and treatmentBCLC staging and treatmentSem Liv Dis 1999 to J Hepatol 2008;48:S20-S37治愈性治疗（治愈性治疗（3030）5 5年生存率年生存率40%-70%40%-70%肝移植肝移植RF/PEI切除术切除术伴随疾病伴随疾病有有无无3 个结节个结节, 3cm上升上升正常正常单发结节单发结节,

9、2cm门脉压力门脉压力/胆红素胆红素单发结节单发结节多多结节结节, 3cmTACE多个肿瘤多个肿瘤门脉转移门脉转移,N1,M1PS: performance status，ECOG体能状态评分体能状态评分 CP: Child-Pugh 评级评级新药治疗新药治疗索拉非尼索拉非尼第52页/共108页53第53页/共108页54第54页/共108页55第55页/共108页56* 中华医学杂志中华医学杂志, 2003 , 83 (12):1053-7.第56页/共108页57第57页/共108页58第58页/共108页59口服药物：最新研究结果在重要医学杂志先后发表口服药物：最新研究结果在重要医学杂志

10、先后发表SHARP研究研究New England Journal Medicine Llovet JM et al，2008;359:378-90.Oriental研究研究Lancet Oncology Cheng AL et al，2008年年12月在线发表月在线发表Llovet JM et al. N Engl J Med 2008;359:378-90.Cheng AL et al. Lacnet Oncoligy 2008 Dec 17 online publish .第59页/共108页第60页/共108页第61页/共108页62第62页/共108页63This large soli

11、tary metastatic nodule was from a colon primary; the glairy cut surface represents a high mucin content. 第63页/共108页64Multiple confluent nodules with central umbilication and peripheral hyperemia are classic for metastasis to liver; the primary here was a breast carcinoma. 第64页/共108页65第65页/共108页66第66

12、页/共108页67第67页/共108页68第68页/共108页69第69页/共108页70第70页/共108页71第71页/共108页第72页/共108页第73页/共108页74第74页/共108页75The honeycomb appearance and vascular nature of this giant cavernous hemangioma are readily apparent from the capsular surface. 第75页/共108页76HemangiomasSequential changes during angiograpgy: a vascula

13、r lesion with delayed clearing of the contrast medium. 第76页/共108页77The cut surface of this hemangioma varies from honeycomb to spongy to fibrotic (photograph courtesy of S. Goetz, M.D.). 第77页/共108页第78页/共108页79第79页/共108页80Polycystic liver and kidney disease at autopsy; the liver was completely normal

14、 functionally (photograph courtesy of Chris Reuter, M.D.). 第80页/共108页81Hepatic cysts-imaging findingsHepatic cysts with intra-abdominal hydrops第81页/共108页82第82页/共108页第83页/共108页84第84页/共108页85Liver adenoma第85页/共108页86The cut surface of the liver reveals the hepatic adenoma. Note how well circumscribed

15、it is. The remaining liver is a pale yellow brown because of fatty change from chronic alcoholism.第86页/共108页87Hepatic adenomas can become so large as to be life-threatening. This estrogen related adenoma, benign histologically, replaced much of the liver, leading to the patients demise. 第87页/共108页88

16、Hepatic adenomaNormal liver tissue with a portal tract is seen on the left. The hepatic adenoma is on the right and is composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain a normal lobular architecture. The

17、hemorrhagic area represents the peliosis like change commonly seen in estrogen related adenomas (X3.3). 第88页/共108页第89页/共108页90第90页/共108页91Focal nodular hyperplasiaA classic focal nodular hyperplasia, paler than the surrounding liver, and with a distinct central stellate scar. The bands of fibrosis impart an appearance mimicking that of macronodular cirrhosis (Klatskin, X5). 第91页/共108页第92页/共108页93第93页/共108页94第94