【摘要】 目的 探討頸部對稱性脂肪瘤的診斷和治療。 方法 對2004年3月-2010年10月收治的5例頸項部脂肪瘤患者，其臨床癥狀、體征、術前術后處理及結果等臨床資料進行回顧。 結果 5例均為男性，以頸、項部大量皮下脂肪堆積為主要臨床表現，其中1例伴有胸部上分皮下脂肪堆積，呈對稱性隆起。3例患者伴阻塞性睡眠呼吸暫停低通氣綜合征，2例患者有睡眠打鼾但無明顯呼吸暫停。4例患者有脂肪肝和長期酗酒史，但肝功能無異常改變，其中1例（1/4）有多次乙醇中毒史。1例患者無酗酒史，但訴經常作頸部刮痧治療。5例均行外科手術切除，術中見腫瘤為白色無包膜脂肪組織。術后隨訪3個月~2年，1例術后1年復發，未行再次治療，其余未見明顯復發。 結論 頸部對稱性脂肪瘤是脂肪組織彌漫性、對稱性沉積于頸胸部皮下淺筋膜間隙和（或）深筋膜間隙的良性疾病。患者以中年男性居多，長期的酗酒史及典型的臨床表現對于該病的診斷有一定幫助，但酗酒可能并非唯一病因。對于影響美觀及功能的患者，其手術療效較理想。【Abstract】 Objective To explore the diagnosis and treatment of symmetric lipomatosis in the neck. Methods We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010. Results All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group. Conclusions Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.
ObjectiveTo summarize clinicopathologic and immunophenotypic features of hepatic epithelioid angiomyolipoma (HEAML) and to explore its diagnostic and differential diagnostic methods.MethodThe clinical and imaging manifestations, pathological morphology and immunohistochemical features of 5 patients with HEAML from August 2011 to December 2017 in this hospital were retrospectively analyzed.ResultsThere were 2 males and 3 females in the 5 patients with HEAML, aged 38–64 years with an average age of 50 years. There were 2 cases of the left lobe tumors and 3 cases of the right lobe tumors. Three cases were diagnosed as the hepatocellular carcinoma and the other two cases were diagnosed as the hepatic hamartoma and (or) hemangioma by the preoperative imaging examination. The diameter of tumors ranged from 1.5 cm to 7.0 cm, with an average of 3.6 cm. Microscopically, the tumors were composed of more epithelioid smooth muscle cells, parenchyma vessels and a small amount of fat. The immunohistochemical results showed that the melan-A, HMB45, and SMA were positive, while the HepPar-1, AE1/AE3, EMA, CD117, Dog-1, CD10, CgA, Syn, and Desmin were negative. The Ki-67 proliferation index was 2%–10%. The patients were all alive without the tumor recurrence after following up for 2–76 months with an average of 31.4 months.ConclusionsHEAML is a rare primary mesenchymal tumor of liver, which should be misdiagnosed for other benign or malignant tumors for influencing clinical treatment. Diagnosis and differential diagnosis can be made by histopathology and immunohistochemical staining.
【摘要】 目的 探討肝臟血管平滑肌脂肪瘤（hepatic angiomyolipoma，HAML）的多層螺旋CT影像學表現特征及其與病理學基礎的相關性，以進一步提高CT診斷的準確性。 方法 收集2008年11月-2010年12月經手術病理證實的16例HAML患者。所有患者均行螺旋CT平掃及動脈期、門脈期增強檢查，重點觀察HAML的分型及其相應CT表現及影像-病理的相關性。 結果 16例患者共20個病灶，19個為稍低密度病灶，其中11個病灶內可見明顯的脂肪密度影；1個為稍高密度病灶。動脈期所有病灶均有不同程度的強化表現，15個病灶內可見到較明顯條狀及扭曲的血管影。門脈期15個病灶有持續強化。 結論 多層螺旋CT能準確反映HAML的分型及其病理特征，對臨床表現不典型患者的診斷和鑒別診斷有較大診斷價值。【Abstract】 Objective To discuss the correlation between the features of multislice spiral CT results for hepatic angiomyolipoma (HAML) and their pathological basis, and to further improve the diagnostic accuracy through CT examination. Methods Sixteen HAML patients diagnosed pathologically between November 2008 and December 2010 in our hospital were enrolled in our study. All patients underwent multi-slice spiral CT scanning of pre-and post-contrast arterial phase, and portal venous phase. Focus was put on observation of HAML types and their corresponding manifestations, and the correlation between CT imaging and the pathologic basis. Results There were 20 lesions in the 16 patients. Among the 19 hypodense lesions, 11 were clearly seen with fat density shadow. One out of the 20 lesions showed as slightly hyperdense. On the arterial phase scanning, all lesions showed enhancement, and obvious vascular shadow could be seen in15 lesions. On the portal venous phase, 15 lesions continued to strengthen. Conclusions Multi-slice spiral CT can accurately reflect the classification of HAML and its pathological features. It has a great value in the diagnosis and differential diagnosis of patients without typical clinical manifestations.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
