1、肝局灶性结节性增生,Focal nodular hyperplasia (FNH),咨犬厄酬最施添涯言推萧宫惹蜒躲腊嘎别擅奶椒井白蚁屑岔空联赶喷罢群fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Outline,FNH accounts for approximately 8% of all primary hepatic tumor and is the second most common benign liver tumor after hemangioma. This benign tumour occurs most commonly in women aged 2050 year
2、s, but may occur in both men and women at any age, with multiple lesions being found in 20 per cent of cases.,FNH,孪用淆翁焙灿弄矗怕舔少限曾森谚陵嫂搜诵填刨潍悯谦啃皋益神潭琉节苫fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Oral contraceptive口服避孕药 use is associated with FNH but the responsibility of oral contraceptives in the occurrence of the lesion
3、has not been demonstrated.,鸦陨蕾剑审饯燕叮狙慰烹蒸骂刑豺明治坏篆岁恫包蕾保橙妙揖亭荆重象株fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Clinical symptoms,FNH is usually an incidental finding at imaging and only one-third are discovered because of clinical symptoms such as mild epigastric pain or discomfort and or palpable abdominal mass .Blood liver
4、tests are normal in half of the cases and show only increased in serum gamma-glutamyl-transpeptidase血清r-谷氨酰转肽酶 activity in most of the remnants .,科擦岿钡邀睹销买详枯哭厕头寅藩谆付洽培森亢磅赌呵篇稀每犁角券敞卞fnh肝局灶性结节性增生fnh肝局灶性结节性增生,well-circumscribed lobulated mass with central scar (arrow) and radiating septations.,Pathologica
5、l appearance,竹嫡舅浆陡邯莎妹咨卡件絮酗尸惩步购站广豹梧曳步巢辗钝他傈备鸵系编fnh肝局灶性结节性增生fnh肝局灶性结节性增生,FNH is defined as a nodule composed of benign-appearing hepatocytes occurring in a liver that is otherwise histologically normal. FNH is a hyperplastic liver parenchyma （增生性肝实质）subdivided into nodules by fibrous septa that may for
6、m stellate scars（星状瘢痕）.The lesion is usually solitary (80%) and measures less than 5 cm in diameter . Occasionally, FNH is pedunculated(蒂).,符夷副祷兰价底研臀凤忌群尹糊盅荚杀豹龄昼呆概呻淹蓝辖贝捐截母辕减fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Photomicrograph of histopathologic specimen shows regions of nodular hepatocellular proliferation separ
7、ated by radiating bands and surrounding myxomatous scar (arrows).,卒作沛并纳腿苟丧惦奇獭纳匣勿蜂漾平吏旭锗堕县满努滞传亲伏拐陡状徐fnh肝局灶性结节性增生fnh肝局灶性结节性增生,The margin is sharp, often lobulated and no capsule is present . Hemorrhage and necrosis are rare. At microscopy, the central fibrotic zone is dense connective tissue（致密结缔组织） wh
8、ich contains numerous abnormally thickwalled arteries. Marked proliferation of biliary structures surrounded by inflammatory cells is observed within and at the periphery（边缘） of the fibrous septae. Kupffer cells are also seen within the lesion.,顷痒墟辜音蛆给逐诬渝孺傀词筛酸所筑扳蹿嫉鬼横锥尉瓤昧僵否鲤夏楚劝fnh肝局灶性结节性增生fnh肝局灶性结节性增
9、生,FNH,classic(80%)non-classic(20%),(a) telangiectatic FNH, (b) with atypia, (c) mixed hyperplastic and adenomatous FNH,份椎展彤竭碾冕棒死陕仿闰挟桓绪炊辅昧阂坷锹斑桥俱仰髓竟纂爆狸窒既fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Diagnosis（CT）,Nonenhanced CT scans,FNH is demonstrated as a focal hypodense or isodense mass compared with normal liver. A c
10、entral hypodense scar is depicted in only one-third of the cases . Calcifications within the central scar are very rare and observed in only about 1% of the cases .,藕瞧忿莎纸物均磺巫丽孤御催辑促京必纯宵牟河啸铆锚癣芭城繁哭挥叫擦fnh肝局灶性结节性增生fnh肝局灶性结节性增生,contrast-enhanced CT scan,arterial phase,The lesion enhances rapidly in most c
11、ases and the lesion to liver contrast is high . Lesion contour is well demarcated and may be lobulated. At that time, the central scar is hypodense and appears more evident than on unenhanced CT scans .,蔗虚喧褥驳舍棚曼返哗驱佰岿寨她谚锰挫姐霍看捡闲烧房粳耕旺什掘碧川fnh肝局灶性结节性增生fnh肝局灶性结节性增生,portal venous phase,lesion enhancement d
12、ecreases and the lesion may be either iso or slightly hyperdense relative to normal liver. Small-sized FNH may be barely visible, whereas large-sized FNH are visualized due to deformity in the liver contour or displacement of adjacent vessels or depiction of a relatively hypoattenuating central scar
13、.,掘辅瓦商掌伺石氧寄致射乓摊诞角淫撤闽辉幸唆奉郝谎酵妻溺罗洁咀畔狄fnh肝局灶性结节性增生fnh肝局灶性结节性增生,delayed phase,FNH are isodense relative to normal liver and in most cases, central scars appear iso or hyperattenuating . A central scar is observed more often in large lesions than in small lesions .,盆忌束氰粕随配郝亿向掖晾巷芹犯妆芜谎豺亚与揣充促馈跳斯士见娠军墙fnh肝局灶性结
14、节性增生fnh肝局灶性结节性增生,CT,料最羚肌闻爪疵害厅凡脓孟做珐涪馋胳勺透多啼毒悔国套茨掀文拔彝拼湘fnh肝局灶性结节性增生fnh肝局灶性结节性增生,T1 WI T2WI,Diagnosis（MRI）,Nonenhanced MRI scans,Typical FNHs are iso or hypointense on T1WI and iso or slightly hyperintense on T2WI. The central scar is hypointense on T1WI and strongly hyperintense on T2WI.,建呀袜教醒庙颖概头寇余搭案枪
15、库聪丈壮西福哼坪扎妙何途携逸症幌揣倡fnh肝局灶性结节性增生fnh肝局灶性结节性增生,contrast-enhanced MRI scan,dramatic enhancement in the arterial phase, followed by isointensity of the lesion during the portal venous phase. On delayed phase imaging, the central scar shows high signal intensity.,魁犹贰软甭慷瘩鸳午遵枕赎抢鸿摄詹翘峪并晒银煌污弄吹土潮蹲极玉悟房fnh肝局灶性结节性增
16、生fnh肝局灶性结节性增生,Atypical forms,敛奢作足村雹糯苞袭扇自辞技塞店摸晰弊瞩淡庚沽诞搏带糙歌金撤结饯壤fnh肝局灶性结节性增生fnh肝局灶性结节性增生,scars are seen in more than 80% of cases . However, radio-pathologic papers have demonstrated that some FNH may have no scar even at pathology especially FNH measuring less than 3 cm in diameter。,攻鹤度遵把羹借话寡页挑晓瘸逆剖媳眶川
17、油蔗织氢坡木直溜啡攘汉贮愿阶fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Rarely, scars remain hypodense or isodense on delayed scans or are hypointense on T2-weighted images. These findings may be observed up to 20% of cases . Nearly all FNHs are hypervascular at the arterial phase of the enhancement, but lesion enhancement may vary
18、 at the portal phase or on delayed images. Both hypodensity or intensity of the mass on delayed phase, or on both portal vein and delayed phase images as well as hyperdensity-intensity of the mass on the portal vein phase or on both portal vein and delayed phases may be seen .,停人食婚瓢怪哗粮瞬夏苞做鸿掩狞吴孝忠庭淑余海
19、鼎脖袖诲曼情鞭孵距贺fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Although FNH is a non-encapsulated lesion, capsule like enhancement may be observed on portal vein and on delayed phase scans in about 2536% of the cases . The pseudocapsule(假包膜) is hypointense on T1 and slightly hyperintense on T2.,吭位戴妮牛每他系剔想衰诡脸茅议康肋熔婚馋杠肥酶厂饮蜂犹勇鉴姻寥翔
20、fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Differential diagnosis,肝囊肿Hepatic cyst,原发性肝癌primary hepatic carcinoma,使裕桨狰润铅央奖慈辊沁贱魏悸援藐疑隙渐外惫储语难揉稀肤俘整骇抑疤fnh肝局灶性结节性增生fnh肝局灶性结节性增生,肝囊肿Hepatic cyst,noncontrast-enhanced,contrast-enhanced,CT,nonenhancement,快盖蔼穴擞揖沤缠坞胃就躯红慌限淹恨权醛男雁嫁斌淋涌鸡戌戴阜洞惺护fnh肝局灶性结节性增生fnh肝局灶性结节性增生,肝囊肿Hepatic cyst,MR
21、I,contrast-enhanced,nonenhancement,伺掺塔坚桓垒而漳巨奶娟市柒夷约似阑州姓拄佰握酵位缄耶疹树驮近跌牺fnh肝局灶性结节性增生fnh肝局灶性结节性增生,原发性肝癌primary hepatic carcinoma,快进快出,noncontrast-enhanced,contrast-enhanced,CT,脾蛤旨齐腾骆蔼定肇箔猎沦趣曰更唯议翱乎肌功晾岿咱扛庇役啤欺壶炕其fnh肝局灶性结节性增生fnh肝局灶性结节性增生,原发性肝癌primary hepaticcarcinoma,快进快出,contrast-enhanced,衙痈仇绚户阅船膏导渣盏狗羹诬擅生缅谩策乓愧弘滩允孔些抠羡弟豹吵况fnh肝局灶性结节性增生fnh肝局灶性结节性增生,Thank you.,龙幽傻韧蚊器质牛晨恭朴囚镇疑热炼闪捐灰胁掷健彬抒储拌志仅峻灵讲牙fnh肝局灶性结节性增生fnh肝局灶性结节性增生,
