《假性淋巴瘤肝脏》PPT课件

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1、AcaseofhepaticpseudolymphomaLiuchenhanDepartmentofradiology,SirRunRunShawHospitalCASE:1443371F,64Y，体检发现肝脏肿物半月余。症状、体征（-）既往：肝Ⅳ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：（-）eWorldViewImageeWorl

2、dViewImageCT: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

3、浸润。免疫组化（B片）：CD3&CD20&CD5&CD10&CD43&CD15&CD21&CD23&CD30&Bcl2&Bcl6&Kappa&Lambda&Ki67：未见异常表达，EBER：－，D240：内皮细胞+。BCR：IgH基因重排：Fr2A+Fr2B：阴性；Fr3A：阴性；IgK基因重排：阴性。（肝）淋巴组织反应性增生，考虑为假性淋巴瘤backgroundPseudolymphoma(PL)wasfirstdescribedinthelungbySalt-zsteinin1963asalymphocytictumorassociatedwithinflammationandw

4、ithnoevidenceofsystemicdissemination.PLoftheliverwasfirstreportedbySnoveretalin1981.PLcanbefoundinthegastrointestinaltract,orbit,andpancreas,butrarelyintheliver.backgroundHepaticpseudolymphoma(HPL),alsotermedasreactivelymphoidhyperplasia,ornodularlymphoidlesion.HPLhasbenignbehavior.HPLisanextre

5、melyrarecondition,withmostreportstodatedealingwithsinglecases.EtiopathogenesisTheexactetiologyremainsunknown.Itisspeculatedthatchronicinfectionorinflammatoryprocesssuggeststheircorrelationwithimmunologicalresponse.HPLcandevelopinpatientswithautoimmunediseases,malignancy,orhepatitisorwhoareadmin

6、isteredinterferontherapy.BasedonareviewofthePubMeddatabasefrom1981to2012usingthekeywords“pseudolymphoma”and“lymphoidhyperplasiaoftheliver”,wefound64lesionsin46casesofpseudolymphoma.LiteraturereviewF/M:42:5Mostofthecases(69.6%)werereportedinJapan.Theaveragesizeofthetumorwas15.1+/-10.6mm,mostofth

7、etumors(90.6%)werenomorethan20mm.Mostofthelesionsreportedaresingleinnumber.ImagingfindingsOnCT,ahypodensemassonunenhancedimagesthatisslightenhancedonearly-phaseimagesaftercontrastinjectionandsubsequentwashout.OnMRI,slightT1andT2pr