今日の臨床サポート

肝良性腫瘍(肝血管腫、アデノーマ)

著者: 中尾一彦 長崎大学 消化器内科

監修: 金子周一 金沢大学大学院

著者校正/監修レビュー済:2021/04/14
患者向け説明資料

概要・推奨   

  1. 肝血管腫によって臨床症状、身体所見を呈することはほとんどない。巨大血管腫の場合、きわめてまれに上腹部不快感、右上腹部痛、圧排による閉塞性黄疸、胃拡張などの症状を来すことがある。
  1. 肝腺腫では、経口避妊薬内服の有無、服薬期間などを聴取する。妊娠の有無も確認する。糖原病の病歴の有無を確認する。
  1. 肝腺腫は多くの場合、無症状であるが、巨大な腺腫の場合、上腹部不快感、圧迫感などの症状を認める。腫瘍破裂や、腫瘍内出血を起こした場合は、突然の腹痛を来す。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
中尾一彦 : 未申告[2021年]
監修:金子周一 : 研究費・助成金など(バイエル薬品株式会社,株式会社キュービクス,アボットジャパン合同会社,日東電工株式会社,株式会社スギ薬局,株式会社サイトパスファインダー),奨学(奨励)寄付など(小野薬品工業株式会社,エーザイ株式会社,株式会社ツムラ,アッヴィ合同会社,大日本住友製薬株式会社,ゼリア新薬工業株式会社,塩野義製薬株式会社,大塚製薬株式会社,アステラス製薬株式会社,田辺三菱製薬株式会社,マイランEPD合同会社,EAファーマ株式会社,大鵬薬品工業株式会社,中外製薬株式会社,協和キリン株式会社,持田製薬株式会社,日本ケミファ株式会社,LifeScan Japan株式会社)[2021年]

改訂のポイント:
  1. 定期レビューを行い、概要、推奨について加筆した。

病態・疫学・診察

疾患情報(疫学・病態)  
肝血管腫:
  1. 肝血管腫は良性の肝腫瘍の中で最も頻度が高く、剖検例の約5%にみられる。中高年>若年、女性>男性、肝右葉に多くみられる。大きさは数mmから数cmまでさまざまだが、ほとんどが無症状で健診時の腹部超音波検査で偶然発見されることが多い[1][2]
  1. 肝血管腫の割面は暗赤色でスポンジ状を呈し、組織像は内皮細胞で覆われた多数の血管腔と線維性隔壁からなる。
  1. 肝血管腫は部分的な壊死、石灰化、線維化、硝子様硬化などの退行性変化を来し、このため典型的な画像所見を示さないことがある。硝子様硬化が著しい血管腫をsclerosed hemangiomaまたはhyalinized hemangioma (硝子様血管腫)と呼ぶ[1][3]
  1. 多くの場合、無症状で経過し治療の必要はない[1][2]。大きな血管腫の場合、きわめてまれに周辺臓器の圧排、血管腫内の出血、血栓形成、血管腫の破裂により、上腹部不快感、右季肋部痛などの症状を来すことがある[4]。巨大血管腫内に大量の血栓が生じ、血小板、凝固因子が消費され播種性血管内凝固症候群(DIC)となる病態をKasabach-Merritt症候群と呼ぶ[5]。このように症状や合併症を伴う場合は外科的切除の適応となる。
 
肝腺腫:アデノーマ:
  1. 肝腺腫は肝細胞由来の良性腫瘍で20~40歳代の女性に好発し、経口避妊薬内服(5年以上の内服)との関連が深い[6]。発生頻度は肝血管腫、限局性結節性過形成(focal nodular hyperplasia、FNH)より低く、欧米での頻度は10万人に4人程度[7]であるが、わが国の頻度はさらに低いとされる[8]
  1. 肝腺腫は糖原病1型の22~75%、3型の25%に合併するとされ、多くは20歳以下で肝腺腫が発生する[9][10]
  1. 転写因子HNF-1αの遺伝子変異がMODY(maturity-onset diabetes of the young)に加えて肝腺腫の原因になることも報告されている[11]
  1. 肝腺腫は正常肝に発生し、境界明瞭な充実性腫瘍で被膜を伴うことがあり、しばしば腫瘍内に出血や壊死を伴う。組織学的には異型に乏しい核とグリコーゲンに富む明調な胞体を持つ腫瘍細胞が、索状、敷石状に配列し、腫瘍内には門脈域は存在しない[12]
  1. 多くの場合、無症状であるが、巨大な腺腫の場合、上腹部不快感、圧迫感などの症状を認める[8][13]。腫瘍破裂や、腫瘍内出血を起こした場合は、突然の腹痛を来し、貧血、白血球増加を認める[8][14]。巨大な腺腫や多発する腺腫は悪性化することがある[15][16]
問診・診察のポイント  
肝血管腫:
  1. 肝血管腫によって臨床症状、身体所見を呈することはほとんどない[1][2]。巨大血管腫の場合、きわめてまれに上腹部不快感、右上腹部痛、圧排による閉塞性黄疸、胃拡張などの症状を来すことがある[4]
 
肝腺腫:アデノーマ:
  1. 肝腺腫では、経口避妊薬内服の有無、服薬期間などを聴取する。妊娠の有無も確認する。糖原病の病歴の有無を確認する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
常時アップデートされており、最新のエビデンスを各分野のエキスパートが豊富な図表や処方・検査例を交えて分かりやすく解説。日常臨床で遭遇するほぼ全ての症状・疾患から薬剤・検査情報まで瞬時に検索可能です。

まずは15日間無料トライアル
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: Sam S Yoon, Caleb K Charny, Yuman Fong, William R Jarnagin, Lawrence H Schwartz, Leslie H Blumgart, Ronald P DeMatteo
雑誌名: J Am Coll Surg. 2003 Sep;197(3):392-402. doi: 10.1016/S1072-7515(03)00420-4.
Abstract/Text BACKGROUND: Hepatic hemangiomas are congenital vascular malformations and are the most common benign hepatic tumors. Because the use of cross-sectional imaging has increased, benign hepatic tumors, especially hemangiomas, are encountered more frequently, so clinicians should be familiar with the most appropriate diagnostic tests, management, and outcomes of patients with hepatic hemangioma.
STUDY DESIGN: All patients with a primary diagnosis of hepatic hemangioma referred for surgical evaluation at our institution between January 1992 and December 2000 were identified from a prospective database. Demographics, presentation, tumor characteristics, diagnostic studies, surgical procedures, and outcomes were analyzed. RESULTS; Of 115 patients in the study, nearly half were asymptomatic. In symptomatic patients, abdominal pain or discomfort was the most common presenting symptom. At our institution, the diagnosis of hemangioma was established by ultrasonographic studies in 57% of patients tested, by CT scan in 73%, and by MRI in 84%. In patients with large tumors considered for resection, direct angiography or, more recently, CT angiography, confirmed the diagnosis in 27 of 29 patients (93%). Enucleation was performed in 31 (60%) of the 52 patients who underwent surgical resection; 63 patients were observed. Postoperative complications occurred in 13 patients (25%), and there were no perioperative deaths. Of the patients with symptoms before resection, 96% had resolution of symptoms after operation.
CONCLUSIONS: Hepatic hemangioma can be diagnosed in most patients using noninvasive studies, particularly MRI. Hepatic hemangiomas can be removed safely if patients become symptomatic or when malignancy cannot be excluded. CT angiography can be a valuable preoperative study in patients with large tumors, and enucleation is the procedure of choice. In asymptomatic or minimally symptomatic patients, hepatic hemangiomas usually have a benign course and can be observed.

PMID 12946794  J Am Coll Surg. 2003 Sep;197(3):392-402. doi: 10.1016/S・・・
著者: H C Cheng, S H Tsai, J H Chiang, C Y Chang
雑誌名: AJR Am J Roentgenol. 1995 Oct;165(4):1016-7. doi: 10.2214/ajr.165.4.7676959.
Abstract/Text
PMID 7676959  AJR Am J Roentgenol. 1995 Oct;165(4):1016-7. doi: 10.22・・・
著者: D Pateron, G Babany, J Belghiti, A Hadengue, Y Menu, J F Flejou, S Erlinger, J P Benhamou
雑誌名: Dig Dis Sci. 1991 Apr;36(4):524-7.
Abstract/Text In conclusion, we report the cases of two patients with large hemangiomas of the liver, abdominal pain, increased ESR and fibrinogen, increased serum alkaline phosphatase and gamma-glutamyltransferase activity, and normal white blood cell counts. Clinical and biochemical abnormalities disappeared after surgical resection. Increased ESR and fibrinogen are probably related to thrombosis within the tumor. This mode of presentation may suggest a diagnosis of hepatocellular carcinoma.

PMID 2007371  Dig Dis Sci. 1991 Apr;36(4):524-7.
著者: G W Hall
雑誌名: Br J Haematol. 2001 Mar;112(4):851-62.
Abstract/Text
PMID 11298580  Br J Haematol. 2001 Mar;112(4):851-62.
著者: H A Edmondson, B Henderson, B Benton
雑誌名: N Engl J Med. 1976 Feb 26;294(9):470-2. doi: 10.1056/NEJM197602262940904.
Abstract/Text During the past six years an increasing number of liver-cell adenomas in women were diagnosed, and we undertook a study of possible etiologic factors, including use of oral contraceptives, in 42 women. There was a significant difference between cases and matched controls in mean months of oral-contraceptive use: 73.4 as compared to 36.2 (P less than 0.001). The women with adenomas took mestranol-containing pills much more commonly than the controls (P less than 0.0001). Hemorrhage into the tumor was often associated with the onset of menstruation in women taking oral contraceptives. Long-term use of oral contraceptives, especially those containing a high total dose of steroids or mestranol as the synthetic estrogen, should be balanced against risks of side effects of the drugs.

PMID 173996  N Engl J Med. 1976 Feb 26;294(9):470-2. doi: 10.1056/NE・・・
著者: J B Rooks, H W Ory, K G Ishak, L T Strauss, J R Greenspan, A P Hill, C W Tyler
雑誌名: JAMA. 1979 Aug 17;242(7):644-8.
Abstract/Text A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.

PMID 221698  JAMA. 1979 Aug 17;242(7):644-8.
著者: P Labrune, P Trioche, I Duvaltier, P Chevalier, M Odièvre
雑誌名: J Pediatr Gastroenterol Nutr. 1997 Mar;24(3):276-9.
Abstract/Text BACKGROUND: Hepatocellular adenomas may develop in patients with glycogen storage disease types I and III, and the malignant degeneration of adenomas in hepatocellular carcinoma has been reported in ten cases. The aim of this work was to study the characteristics of hepatic adenomas in a large series of 43 patients with glycogen storage disease types I and III and to determine the optimal means of follow-up.
METHODS: The charts of 43 patients with glycogen storage disease type I and III were studied. In all these patients, abdominal ultrasonography and the determination of serum alpha-fetoprotein had been performed yearly and serum concentrations of several proteins were determined once.
RESULTS: 51.8% of patients with type I and 25% of patients with type III glycogen storage disease had hepatic adenomas at the time of the study. The male to female ratio was 2 to 1 in type I, and no female had adenomas in type III. No evidence of malignant transformation was observed during the follow-up period. Serum concentrations of several proteins were significantly higher in patients with hepatic adenomas than in patients without such lesions.
CONCLUSIONS: In patients with glycogen storage disease type I and III, the determination of alpha-fetoprotein serum concentration has to be combined with yearly hepatic ultrasound examinations. Other investigations such as CT scan should be considered when the size of any adenoma increases. The malignant transformation of hepatocellular adenoma into hepatocellular carcinoma remains a rare event.

PMID 9138172  J Pediatr Gastroenterol Nutr. 1997 Mar;24(3):276-9.
著者: G M Talente, R A Coleman, C Alter, L Baker, B I Brown, R A Cannon, Y T Chen, J F Crigler, P Ferreira, J C Haworth, G E Herman, R M Issenman, J P Keating, R Linde, T F Roe, B Senior, J I Wolfsdorf
雑誌名: Ann Intern Med. 1994 Feb 1;120(3):218-26.
Abstract/Text OBJECTIVE: To identify complications amenable to prevention in adults with glycogen storage disease (GSD) types Ia, Ib, and III and to determine the effect of the disease on social factors.
DESIGN: Case series and clinical review.
SETTING: Referral medical centers in the United States and Canada.
PATIENTS: All patients with GSD-Ia (37 patients), GSD-Ib (5 patients), and GSD-III (9 patients) who were 18 years of age or older.
MEASUREMENTS: Ultrasound or radiographic studies identified liver adenomas, nephrocalcinosis, or kidney stones. Radiographic studies identified osteopenia. Reports of the clinical examination, serum chemistry results, and social data were obtained.
RESULTS: For patients with GSD-Ia, problems included short stature (90%), hepatomegaly (100%), hepatic adenomas (75%), anemia (81%), proteinuria or microalbuminuria (67%), kidney calcifications (65%), osteopenia or fractures or both (27%), increased alkaline phosphatase (61%) and gamma-glutamyltransferase (93%) activities, and increased serum cholesterol (76%) and triglyceride (100%) levels. Hyperuricemia was frequent (89%). Patients with GSD-Ib had severe recurrent bacterial infections and gingivitis. In patients with GSD-III, 67% (6 of 9) had increased creatinine kinase activity. Four of these patients had myopathy and cardiomyopathy.
CONCLUSIONS: For GSD-Ia, hyperuricemia and pyelonephritis should be treated to prevent nephrocalcinosis and additional renal damage. For GSD-Ib, granulocyte-colony-stimulating factor may prevent bacterial infections. For GSD-III, more data are required to determine whether the myopathy and cardiomyopathy can be prevented. Most of the patients with GSD-I and GSD-III had 12 or more years of education and were either currently in school or employed.

PMID 8273986  Ann Intern Med. 1994 Feb 1;120(3):218-26.
著者: Yves Reznik, Thong Dao, Regis Coutant, Laurence Chiche, Emmanuelle Jeannot, Severine Clauin, Pierre Rousselot, Monique Fabre, Frederic Oberti, Armelle Fatome, Jessica Zucman-Rossi, Christine Bellanne-Chantelot
雑誌名: J Clin Endocrinol Metab. 2004 Mar;89(3):1476-80. doi: 10.1210/jc.2003-031552.
Abstract/Text Heterozygous germline mutations of the hepatocyte nuclear factor (HNF)-1 alpha are associated with maturity-onset diabetes of the young (MODY)3. Recently, the biallelic inactivation of the HNF-1 alpha gene was reported in liver adenomas. We show the occurrence of liver adenomatosis in six MODY3-affected patients from two unrelated and large families. Liver adenomatosis was characterized by the presence of numerous adenomas within a normal hepatic parenchyma. The HNF-1 alpha hot-spot germline mutation P291fs was identified in the two probands and in 16 relatives from the two families. The six patients affected by liver adenomatosis and diabetes exhibited the mutation. The analysis of liver-cell tumors from two affected patients evidenced the biallelic inactivation of HNF-1 alpha. The familial screening confirmed the clinical heterogeneity of the liver phenotype, from silent liver adenomatosis to fatal hemorrhage. These observations warrant the systematic screening for liver adenomatosis in MODY3 families to prevent its potentially deadly complications. Moreover, such screening may help to determine if a particular mutational spectrum of HNF-1 alpha is associated with liver adenomatosis and to establish its prevalence in this frequent form of diabetes in the young adult.

PMID 15001650  J Clin Endocrinol Metab. 2004 Mar;89(3):1476-80. doi: 1・・・
著者: T Terkivatan, J H de Wilt, R A de Man, R R van Rijn, P E Zondervan, H W Tilanus, J N IJzermans
雑誌名: Arch Surg. 2001 Sep;136(9):1033-8.
Abstract/Text HYPOTHESIS: The natural history and clinical behavior of benign hepatic tumors during long-term follow-up may not justify primary surgical treatment.
DESIGN: Retrospective study.
SETTING: Tertiary referral center.
PATIENTS: Two hundred eight patients diagnosed as having a benign liver tumor between January 1, 1979, and December 31, 1999.
INTERVENTION: Seventy-four patients underwent hepatic surgery and 134 were managed conservatively by radiological follow-up.
MAIN OUTCOME MEASURES: Symptoms and complications were assessed during management and follow-up.
RESULTS: In the surgically treated population, the liver lesion was symptomatic in 47 patients (64%) and an incidental finding in 27 (36%). The operative morbidity and mortality were 27% (20 of 74 patients) and 3% (2 of 74 patients), respectively. Overall, 28 (80%) of 35 patients with complaints were asymptomatic after surgery. During observation of the tumor in the conservatively managed group, 39 (87%) of 45 patients who presented with complaints were asymptomatic during a mean follow-up of 45 months; 6 patients had mild abdominal pain considered to be unrelated to the tumor.
CONCLUSIONS: Conservative management of solid benign liver lesions such as focal nodular hyperplasia and hemangioma can be performed safely, irrespective of their size. We only advise surgery for liver lesions when there is an inability to exclude malignancy or in the case of severe complaints related to the tumor. Resection is always advocated in the case of a large hepatocellular adenoma (>5 cm) to reduce the risk of rupture and malignant degeneration.

PMID 11529826  Arch Surg. 2001 Sep;136(9):1033-8.
著者: R E Fechner
雑誌名: Hum Pathol. 1977 May;8(3):255-68.
Abstract/Text A consecutive series of 12 benign hepatic lesions in women consisted of six cases of focal nodular hyperplasia and six cases of liver cell adenoma. Five of the six women with liver cell adenoma and two of the six with focal nodular hyperplasia had taken orally active contraceptive hormones. These few cases reflect a similar impression gained from a critical analysis of the literature, namely, that focal nodular hyperplasia may be unrelated to the oral administration of contraceptive hormones, whereas the increase in liver cell adenoma reported in recent years is probably related to such therapy. Two women with liver cell adenomas were asymptomatic six and four years after incomplete resection of the tumor. These are the longest intervals thus far reported for uncomplicated survival in incompletely resected liver cell adenoma.

PMID 192659  Hum Pathol. 1977 May;8(3):255-68.
著者: E J Gyorffy, J E Bredfeldt, W C Black
雑誌名: Ann Intern Med. 1989 Mar 15;110(6):489-90.
Abstract/Text
PMID 2537593  Ann Intern Med. 1989 Mar 15;110(6):489-90.
著者: J H Foster, M M Berman
雑誌名: Arch Surg. 1994 Jul;129(7):712-7.
Abstract/Text OBJECTIVE: To investigate clinical experience with the apparent malignant transformation of benign liver cell adenomas.
DESIGN: Retrospective review of personal experience and literature.
SETTING: University hospital and affilated community hospitals.
PATIENTS: All patients diagnosed with liver cell adenomas over a 30-year period.
INTERVENTIONS: Liver resection and/or tumor biopsy.
MAIN OUTCOME MEASURES: Gender, age, drug associations, alpha-fetoprotein levels, response to treatment, and survival.
RESULTS: Thirteen patients from personal experience and 26 patients from the reports of others had liver cell adenomas that were not resected. Five of these patients subsequently developed hepatocellular carcinoma.
CONCLUSIONS: Malignant transformation of a liver cell adenoma is a rare phenomenon, but it does occur. Alpha-fetoprotein levels may be more helpful in diagnosis than expected from previous reports. Solitary benign adenomas should be resected whenever possible. Patients with diffuse multiple tumors should be observed closely over a long period.

PMID 7517661  Arch Surg. 1994 Jul;129(7):712-7.
著者: M Nino-Murcia, E W Olcott, R B Jeffrey, R L Lamm, C F Beaulieu, K A Jain
雑誌名: Radiology. 2000 Jun;215(3):746-51. doi: 10.1148/radiology.215.3.r00jn03746.
Abstract/Text PURPOSE: To present our early experience with a classification scheme for categorizing focal liver lesions on the basis of the enhancement patterns that they exhibit in the arterial phase of computed tomography (CT) and to determine whether particular enhancement patterns suggest particular diagnoses.
MATERIALS AND METHODS: The authors reviewed arterial phase CT images in 100 consecutive patients with focal liver lesions, excluding simple cysts. The enhancement pattern of the dominant or representative lesion in each patient was classified into one of five categories-homogeneous, abnormal internal vessels or variegated, peripheral puddles, complete ring, or incomplete ring-by three radiologists blinded to the proved diagnosis. Lesions without enhancement were recorded separately. Agreement was reached by consensus in all cases. Standards of reference included findings at histologic examination, correlative imaging, or clinical and imaging follow-up.
RESULTS: Ninety-two percent of the 100 lesions demonstrated arterial phase enhancement. Patterns associated with positive predictive values of 82% or greater and specificity of 80% or greater included abnormal internal vessels or variegated (hepatocellular carcinoma), peripheral puddles (hemangioma), and complete ring (metastasis).
CONCLUSION: The appearance of hepatic lesions in the arterial phase of enhancement has potential use in the determination of specific diagnoses. The classification scheme used in this study may be a useful tool for the interpretation of arterial phase CT studies.

PMID 10831693  Radiology. 2000 Jun;215(3):746-51. doi: 10.1148/radiolo・・・
著者: S F Quinn, G G Benjamin
雑誌名: Radiology. 1992 Feb;182(2):545-8. doi: 10.1148/radiology.182.2.1732978.
Abstract/Text Many hepatic hemangiomas are discovered incidentally during incremental dynamic bolus computed tomography (CT). To meet the established criteria for diagnosis with CT, however, a second CT examination with single-level dynamic bolus imaging is necessary. A prospective evaluation was performed to examine a simple sign that may be used to diagnose cavernous hemangiomas during incremental dynamic bolus CT. This sign is the visualization of foci of globular enhancement within the hemangioma, analogous to areas of puddling of contrast material seen at angiography. A total of 34 lesions in 21 patients demonstrated foci of globular enhancement. Of the 34 lesions, 32 (94%) proved to be hemangiomas. All 21 patients underwent confirmatory evaluation. Foci of globular enhancement seen during dynamic bolus CT are a strong indication that the lesion is a cavernous hemangioma. This diagnostic sign may obviate further, more expensive imaging studies.

PMID 1732978  Radiology. 1992 Feb;182(2):545-8. doi: 10.1148/radiolog・・・
著者: Tomoyuki Hida, Akihiro Nishie, Tsuyoshi Tajima, Akinobu Taketomi, Shin-ichi Aishima, Hiroshi Honda
雑誌名: Jpn J Radiol. 2010 Apr;28(3):235-8. doi: 10.1007/s11604-009-0407-3. Epub 2010 May 1.
Abstract/Text We present a case of a sclerosed hemangioma (SH) of the liver that showed a high apparent diffusion coefficient (ADC) value. The patient was undergoing preoperative evaluation for a metastatic breast cancer lesion when a liver mass with a diameter of 3 cm was found. It was described as a heterogeneously hyperechoic mass on ultrasonography and as a well-defined, lobulated mass with early peripheral enhancement and internal heterogeneous enhancement in the delayed phase on computed tomography. The fat-suppressed T2-weighted images demonstrated a heterogeneously hyperintense mass, which showed an ADC value of 2.01 x 10(-3) mm(2)/s. Liver metastasis and cholangiocellular carcinoma could not be excluded based on the imaging findings. After surgery, a definite diagnosis of SH was obtained. Microscopically, many hyalinized portions with poor cellular and fibrous components were observed in the tumor, and this hyalinization accompanied with liquiform degeneration, which may have been one of the causes of the high ADC value. We discuss the diagnostic value of diffusion-weighted imaging for SH of the liver.

PMID 20437137  Jpn J Radiol. 2010 Apr;28(3):235-8. doi: 10.1007/s11604・・・
著者: Luigi Grazioli, Giovanni Morana, Miles A Kirchin, Günther Schneider
雑誌名: Radiology. 2005 Jul;236(1):166-77. doi: 10.1148/radiol.2361040338. Epub 2005 Jun 13.
Abstract/Text PURPOSE: To prospectively determine the accuracy of differentiating benign focal nodular hyperplasia (FNH) from hepatic adenoma (HA) and liver adenomatosis (LA) by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging.
MATERIALS AND METHODS: The ethics committee at each center approved the study, and all patients provided informed consent. Seventy-three patients with confirmed FNH and 35 patients with confirmed HA (n = 27) or LA (n = 8) underwent MR imaging before (T2-weighted half-Fourier rapid acquisition with relaxation enhancement or T2-weighted fast spin-echo and T1-weighted gradient-echo [GRE] sequences) and at 25-30 seconds (arterial phase), 70-90 seconds (portal venous phase), 3-5 minutes (equilibrium phase), and 1-3 hours (delayed phase) after (T1-weighted GRE sequences only, with or without fat suppression) bolus administration of 0.1 mmol per kilogram of body weight gadobenate dimeglumine. The enhancement of 235 lesions (128 FNH, 32 HA, and 75 LA lesions) relative to the normal liver parenchyma was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for the differentiation of FNH from HA and LA were determined.
RESULTS: Hyper- and isointensity on T2-weighted and iso- and hypointensity on T1-weighted GRE images were noted for 177 (88.9%) of 199 lesions visible on unenhanced images. On dynamic phase images after contrast material administration, 231 (98.3%) of 235 lesions showed rapid strong enhancement during the arterial phase and appeared hyper- to isointense during portal venous and equilibrium phases. Accurate differentiation of FNH from HA and LA was not possible on the basis of precontrast or dynamic phase images alone. At 1-3 hours after contrast material enhancement, 124 (96.9%) of 128 FNHs appeared hyper- or isointense, while 107 (100%) HA and LA lesions appeared hypointense. The sensitivity, specificity, PPV, NPV, and overall accuracy for the differentiation of FNH from HA and LA were 96.9%, 100%, 100%, 96.4%, and 98.3%, respectively.
CONCLUSION: Accurate differentiation of FNH from HA and LA is achievable on delayed T1-weighted GRE images after administration of gadobenate dimeglumine.

Copyright RSNA, 2005
PMID 15955857  Radiology. 2005 Jul;236(1):166-77. doi: 10.1148/radiol.・・・
著者: O Farges, S Daradkeh, H Bismuth
雑誌名: World J Surg. 1995 Jan-Feb;19(1):19-24.
Abstract/Text A total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio-computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty-seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n = 8), embolization (n = 5), or hepatic artery ligation (n = 1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty-five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.

PMID 7740805  World J Surg. 1995 Jan-Feb;19(1):19-24.
著者: F C Nichols, J A van Heerden, L H Weiland
雑誌名: Surg Clin North Am. 1989 Apr;69(2):297-314.
Abstract/Text From a practical standpoint, the most important benign hepatic tumors are hepatocytic adenoma, focal nodular hyperplasia, cavernous hemangioma, and bile duct hamartoma. The surgeon needs to be familiar with the pathogenesis, gross and radiologic appearance, and natural history of each of these lesions to formulate an appropriate therapeutic plan.

PMID 2538935  Surg Clin North Am. 1989 Apr;69(2):297-314.
著者: John F Gibbs, Alan M Litwin, Morton S Kahlenberg
雑誌名: Surg Clin North Am. 2004 Apr;84(2):463-80. doi: 10.1016/j.suc.2003.11.003.
Abstract/Text Benign lesions of the liver represent diagnostic dilemmas, clinically and radiographically; however, certain clues can help the extensive differential diagnosis of both benign and malignant processes. Hemangiomas and simple cysts have very distinct and very specific radiographic characteristics, and if diagnosed, no further work-up is necessary. The remaining benign lesions have significant overlap, even though there are some more common characteristics to each of the entities. Still, differentiation of any particular lesion outside simple cysts or hemangioma may be difficult. It is reasonable and relatively simple, with minimal invasiveness, to perform US- or CT-guided, percutaneous core-needle biopsies. It is recommended that core biopsies be performed, because many of the benign entities have some overlapping histologic features, and if fine-needle aspirations are performed, a definitive diagnosis may be difficult to obtain. A definitive pathological diagnosis still cannot be made in some cases, even after needle biopsy. Therefore, a surgical resection or wedge resection may be necessary if a benign process cannot be definitively ruled out.

PMID 15062656  Surg Clin North Am. 2004 Apr;84(2):463-80. doi: 10.1016・・・
著者: G Klatskin
雑誌名: Gastroenterology. 1977 Aug;73(2):386-94.
Abstract/Text
PMID 194813  Gastroenterology. 1977 Aug;73(2):386-94.
著者: P Aseni, C V Sansalone, C Sammartino, F D Benedetto, G Carrafiello, A Giacomoni, C Osio, M Vertemati, D Forti
雑誌名: J Clin Gastroenterol. 2001 Sep;33(3):234-6.
Abstract/Text We present the case of a 25-year-old woman who developed a large central liver adenoma after 8 years of continuous oral contraceptive use. The first diagnosis was made by ultrasonography, after a rise in plasmatic gamma-glutamyl-transpeptidase and alkaline phosphatase levels was noted. Withdrawal of the oral contraceptive was followed by shrinkage of the adenoma, with complete disappearance 9 months after the diagnosis. Hepatic adenoma (HA) still presents problems in terms of differential diagnosis and clinical management. There are reports of complete or partial regression of an HA after discontinuation of oral contraceptives, but they are poorly documented. To our knowledge, a patient with such rapid disappearance of a large HA has never been reported.

PMID 11500616  J Clin Gastroenterol. 2001 Sep;33(3):234-6.

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから