假性淋巴瘤肝臟11ppt課件

1、 a case of hepatic pseudolymphomaliu chenhan department of radiology, sir run run shaw hospital n腹部腹部b超超:左肝外葉低弱回聲結(jié)節(jié)，建左肝外葉低弱回聲結(jié)節(jié)，建議超聲造影；議超聲造影；eworldview imageeworldview imagenct:左肝ii段邊緣可疑稍低密度灶，請(qǐng)結(jié)合其它檢查或復(fù)查。nmr:左肝外側(cè)葉占位，惡性病灶不能排除，轉(zhuǎn)移？或其他。n腹腔鏡左肝腫塊切除+術(shù)中冰凍 n術(shù)中未見明顯腹水，肝臟無(wú)明顯結(jié)節(jié)性改變，左肝外側(cè)葉可見一大小約2cm腫塊，略突出于肝臟表面，質(zhì)軟，邊界尚

2、清，剖開腫瘤，切面灰黃色，送術(shù)中冰凍提示：淋巴細(xì)胞增生，淋巴瘤待排。 npseudolymphoma(pl) was first described in the lung by salt-zstein in 1963 as a lymphocytic tumor associated with inflammation and with no evidence of systemic dissemination. npl of the liver was first reported by snover et al in 1981.n pl can be found in the gastr

3、ointestinal tract,orbit,and pancreas,but rarely in the liver.nhepatic pseudolymphoma (hpl),also termed as reactive lymphoid hyperplasia, or nodular lymphoid lesion. nhpl has benign behavior.nhpl is an extremely rare condition, with most reports to date dealing with single cases. nthe exact etiology

4、remains unknown.nit is speculated that chronic infection or inflammatory process suggests their correlation with immunological response.nhpl can develop in patients with autoimmune diseases, malignancy, or hepatitis or who are administered interferon therapy. nbased on a review of the pubmed databas

5、e from 1981 to 2012 using the keywords “pseudolymphoma” and “l(fā)ymphoid hyperplasia of the liver”, we found 64 lesions in 46 cases of pseudolymphoma.nf/m: 42:5 nmost of the cases (69.6%) were reported in japan.nthe average size of the tumor was 15.1+/- 10.6 mm, most of the tumors (90.6%) were no more

6、than 20 mm.nmost of the lesions reported are single in number. non ct, a hypodense mass on unenhanced images that is slight enhanced on early-phase images after contrast injection and subsequent washout.non mri, slight t1 and t2 prolongation and restricted diffusion.nhpl consisted of tumorous infilt

7、rates of mature lymphocytes with multiple lymph follicles or clusters of epithelioid histiocytes. lymphocytes characteristically extended into nearby portal tracts. no obvious atypical cells were identified.n ductal structures positive for cytokeratin 7 were entrapped in the peripheral parts of nodu

8、les. in situ hybridization of immunoglobulin light chains revealed b lymphocytes and plasma cells to be polyclonal. in addition, clonal rearrangements of immunoglobulin heavy chains could not be shown in any cases using pcr. at the edge of the nodule, lymphocytic infiltration extends into perinodula

9、rportal tracts (left). compared with the background liver with chronic hepatitis b (right), lymphocytic infiltration is more pronounced in the portal tracts around the nodule nthe diagnosis of hepatic pseudolymphoma can be challenging but might be aided by in situ hybridization,analyses of gene rear

10、rangements, or follow-up based on images.n f,49y, the abdominal ultrasonography showed a hypoechoic lesion, about 20*16*14 mm in size, located in segment 2.nhepatic enzymes(-); hbv surface antigen and hcv antibody were both negativenafp, cea, and ca-199 (-)(a) (ct) scans showed a 20-mm-diameter, sli

11、ghtly hypodense mass with peripheral rim enhancement in arterial phase located in segment 2.(b) (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 hypointensenodule on segment 2 of the liver in the

12、t1-weighted image, and (d) the lesion became hyperintense in the t2-weighted image. (e) arterial portography with computed tomography demonstrated a perfusion defect in segment 2 of the liver. angiography showed a hypervascular lesion on segment 6 of the liver (arrow). (f) however, the small tumor i

13、n segment 2 of the liver on previous ctand mr had no definite tumor stain.n a hypovascular tumor was impressed,and peripheral type cholangiocarcinoma, metastatic tumor, or sclerosed hemangioma should be differentiated.n a left lateral sectionectomy was performed.figure 2pathological findings of the

14、lesion. gross pathologic specimen revealed a well-defined, nonencapsulated, yellowish-white, and 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 wasncomposed o

15、f hyperplastic lymphoid tissue with several enlarged, irregularly shaped, well-demarcated follicles with formation ofngerminal centers distributed evenly in the mass. (a) the lymphocytes containing round nuclei with scant cytoplasm are mainlynsmall in size and mature in appearance with scattered med

16、ium and large cells, ?40. immunohistochemical stain showed that thengerminal centers were composed 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)

17、reactive immunoblastsnpositive to cd30 antibody were evenly distributed in the interfollicular region, ?100. (f) however, the epsteinebarr virus-encodednrna stain was negative, ?40. cd20 (+), b cellsbcl-2 (-) b cells cd3 (+) small t cellsreactive cd30 (+) immunoblastsepsteinebarr virus-encoded rna(-

18、)nthe patient received regular follow-up, and no recurrence was found during 5 years of follow-up.case 2nf,63y, had a history of pbc and resection of the left adrenal gland for primary aldosteronism.nshe was asymptomatic on admission and her condition was generally good.nabdominal ultrasonography sh

19、owed a hypoechoic lesion,10 mm in diameter in segment 7 .nlaboratory tests(-)a: a hypodensenodule 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

20、 images;n a hyperintense nodule on t2-weighted images;na hyperintense nodule in the early phase after injection 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 se

21、gment 7; b: 4 mm nodule in segment 6.nct during arterial portography showing hypointense 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