Hepatocellular adenoma
1. °³¿ä : 20-30´ë ¿©¼º¿¡¼ È£¹ßÇÏ´Â ¾ç¼º °£Á¾¾çÀ¸·Î ¿©¼º¿¡¼ È£¹ßÇÏ´Â °ÍÀ¸·Î º¸¾Æ
È£¸£¸óÀÌ º´Àο¡ °ü¿©ÇÏ´Â °ÍÀ¸·Î »ý°¢µÇ¸ç °æ±¸ÇÇÀÓÁ¦°¡ ¿øÀÎÀû ¿ªÇÒÀ» ÇÑ´Ù.
anabolic steroids, androgen»ç¿ë ȯÀÚ¿¡¼ ºóµµ°¡ Áõ°¡ÇÑ´Ù.
multiple hepatic adenomas´Â glycogen storage disease I°ú °ü·ÃÀÖ´Ù.
Right lobe¿¡ È£¹ßÇϸç, multiple, 10cm ÀÌ»óÀ¸·Î Ä¿Áú¼öµµ ÀÖ´Ù.
Çö¹Ì°æÀûÀ¸·Î Á¤»ó ȤÀº ¾à°£ atypical hepatocyte·Î ±¸¼º.
(cell- glycogenÀÌ Ç³ºÎÇϸç paler & larger)
2. ÀÓ»óÁõ»ó : pain, palpable mass, intratumor hemorrhage
3. Áø´Ü : USG, CT, MRI, selective hepatic arteriography, radionuclide can
Áø´ÜÀº ÀÌ¿Í °°Àº ´Ù¾çÇÑ °Ë»çµéÀÇ Á¶ÇÕÀ¸·Î ÀÌ·ç¾îÁø´Ù.
i) Angiography: ÀüÇüÀûÀ¸·Î´Â hypervascularÇÏÁö¸¸ hypovascular regionµµ Æ÷ÇԵǾî ÀÖ´Ù.
ii) 99mTc scan: defect(cold spot)·Î ³ªÅ¸³ª´Âµ¥ ÀÌ´Â hepatic adenoma¿¡´Â Kupffer cellÀÌ
¾ø±â ¶§¹®ÀÌ´Ù.
iii) MRI : HCC¿Í ¸¶Âù°¡Áö·Î T1-intense appearance
4. Malignant risk´Â ÀûÁö¸¸ 10cmÀÌ»óÀ̰í multiple adenomaÀÏ ¶§ À§Çèµµ°¡ Áõ°¡ÇÑ´Ù.
5. Ä¡·á ¨ç small tumor - imaging surveillence
¨è 8-10cm - op
¨é oral contraceptives stop -> Áß´ÜÈÄ¿¡µµ size°¡ ÁÙÁö ¾ÊÀ¸¸é ¼ö¼úÀû ÀýÁ¦°¡
ÇÊ¿äÇÒ¼öµµ ÀÖ´Ù.
¨ê pregnacy¶§´Â hemorrhage risk°¡ Áõ°¡Çϸç large adenomaȯÀÚ¿¡¼´Â ÀÓ½ÅÀ»
ÇÇÇØ¾ß ÇÑ´Ù.
¨ë multiple larger adenoma(glycogen-storage disease) - liver transplantation
Focal nodular hyperplasia(FNH)
FNH´Â ¾ç¼º Á¾¾çÀÌ¸ç °Ë»ç ¶Ç´Â ´Ù¸¥ ÀÌÀ¯·Î º¹°°æ °Ë»çÁß ¿ì¿¬È÷ ¹ß°ßµÈ´Ù.
hepatic adenomaó·³ ¿©ÀÚ¿¡ ÁÖ·Î »ý±âÁö¸¸ °æ±¸ ÇÇÀÓÁ¦¿Í´Â °ü·Ã ¾ø°í hemorrhage &
necrosisµµ µå¹°´Ù. ÃâÇ÷ À§Ç輺Àº °æ±¸ ÇÇÀÓÁ¦¸¦ º¹¿ëÇÏ´Â ¿©¼º¿¡¼ ´õ ³ô´Ù.
ÀüÇüÀûÀ¸·Î ÀÌ º´º¯Àº solid tumorÀ̸ç ÁÖ·Î right lobe¿¡ »ý±â°í, fibrous core & stellate
projections ÇÑ´Ù.
fibrous projection¿¡´Â atypical hepatocytes, biliary epithelium, Kupffer cells, and
inflammatory cellsµé Æ÷ÇԵǾî ÀÖ´Ù. 99mTc scanÀ» Çϸé hot spotÀ¸·Î ³ªÅ¸³ª´Âµ¥ ÀÌ´Â
Kupffer cellÀÌ Á¸ÀçÇϱ⠶§¹®ÀÌ´Ù.
angiography»ó vascularÇϸç, helical CT(º¸´Ù MRI°¡ ´õ reliable)¿¡¼´Â septationÀÌ °üÂûµÉ
¼öµµ ÀÖ´Ù. ÃÊÀ½ÆÄ·Î´Â septation°üÂûÀº µå¹°´Ù.
Áõ»óÀÌ ÀÖ´Â °æ¿ì¿¡¸¸ ¼ö¼úÀÌ ÀûÀÀµÈ´Ù.
Hemangioma and other benign tumors
hemangioma´Â °¡Àå ÈçÇÑ ¾ç¼º °£Á¾¾çÀ¸·Î ¿©ÀÚ¿¡ ¸¹°í º¸Åë ¿ì¿¬È÷ ¹ß°ßµÈ´Ù.
Àüü Àα¸Áß À¯º´·üÀº 0.5-7%Á¤µµÀÌ´Ù.
asymptomatic vascular lesionÀ̸ç MRI³ª contrast-enhanced CT, labeled RBC nuclide
scan, or hepatic angiography·Î ¹ß°ßÇÒ¼ö ÀÖ´Ù.
Å©±â°¡ Ä¿¼ mass effect¸¦ ³ªÅ¸³»Áö ¾Ê´ÂÇÑ Á¦°ÅÇÒ Çʿ䰡 ¾ø´Ù. ÃâÇ÷Àº µå¹°°ú malignant
change´Â ÀϾÁö ¾Ê´Â´Ù.
Nodular regenerative hyperplasia´Â periportal hepatocyte regeneration with surrounding
atrophy·Î ÀÎÇÑ multiple hepatic nodules·Î ÀÌ·ç¾îÁø´Ù. malignancy or connective tissue
diseae¿Í °ü·ÃÀÖ´Ù.
portal hypertensionÀÌ °¡Àå ÈçÇÑ ÀÓ»ó¹ßÇöÀÌ´Ù.
´Ù¸¥ ´ú ÈçÇÑ ¾ç¼ºÁ¾¾çÀ¸·Î´Â bile duct adenoma & cystadenoma°¡ ÀÖ´Ù.