肝血管筋脂肪腫の1例 A CASE OF HEPATIC ANGIOMYOLIPOMA

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症例は45歳の男性.人間ドックの腹部超音波検査にて肝腫瘍を指摘された.超音波では,境界明瞭な高輝度の腫瘍であり, CTでは高吸収域を有した低吸収域を呈し,血管造影では,濃染像として描出された.以上より肝血管筋脂肪腫(HAML)を強く疑うも,悪性腫瘍を否定できず,肝部分切除を施行した. HAMLは,肝良性腫瘍の中できわめて稀な疾患であり,本邦報告例は,われわれが検索しえた範囲内で,自験例を含めて54例に過ぎない.外科的切除を施行されている症例が多いが,近年,生検のみで経過観察される報告例も見られる.しかし,病理組織上,脂肪成分,血管成分,平滑筋成分の増生を特徴とする本疾患では,これら3成分および正常肝細胞の構成比率の違いにより,画像上,多彩な画像を呈しうる.このため,近年における画像診断の発展にもかかわらず,悪性疾患との鑑別は困難である症例もあり,治療方針決定の際には,注意を要すると思われる.

We report a case of hepatic angiomyolipoma (HAML) in a 45-year-old man who was pointed out a hepatic tumor by ultrasonography on medical chekcup. After admission ultrasonography demonstrated a well-demarcated, hyperechoic tumor. Plain CT showed a low-density lesion with a high-density area. Hepatic angiography revealed a deep stained tumor and hypervascularity. From these findings, HAML was highly suspected. But, since possible malignancy could not be ruled out, a partial hepatic resection of the right posterior segment was performed. HAML is extremely rare among hepatic benign tumors, and only 54 cases have been reported in Japan, including ours. Many cases underwent surgical intervention, but recently some cases which were followed up only by biopsy have been reported. Histologically, they were characterized by an admixture of adipose tissue, blood vessels and smooth muscle, so the image findings varied with the difference in these 3 components and normal hepatocytes. Therefore, in spite of a recent development in diagnostic imaging techniques, there are cases which present, preoperatively difficulty to differentiate especially from hepatocellular carcinoma undergoing fatty degeneration or other malignant tumors. No malignant hepatic angiomyolipoma has been reported, but some cases with nuclear atypia can be seen. Therefore, it is necessary to make a careful dicision of therapeutic guideline for this type of tumor.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(10), 2510-2515, 1996-10-25

    Japan Surgical Association

参考文献:  23件中 1-23件 を表示

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各種コード

  • NII論文ID(NAID)
    10008525016
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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