소형간세포암종에서의 초음파와 병리소견의 연관

Abstract

[한글]

고해상력 초음파의 발달과 더불어 수술적 절제가 가능한 소령 간세포암종(이하 소형간암으로 약함)의 발견이 많아졌다. 소형 간암의 초음파 소견은 대개 저에코이며 저에코 달무리, 후방에코 증강, 외측그림자 및 모자이크 양상을 보이고 종양의 크기가 커지면서 고

에코 혹은 혼합에코, 외측 그림자와 모자이크 양상의 빈도가 증가한다고 알려져 있다. 이와 같은 초음파 소견은 소형 간암의 병리 조직학적 특성과 성장양식의 반영으로 여겨지기 때문에 1984년 3월부터 1993년 6월까지 수술적 절제술을 통해 얻은 3cm이하 크기의 소형 간암 20병소를 대상으로 육안적 그리고 조직학적 검색을 하여 초음파 소견과 연관시켜 붐으로써 소형 간암의 진단에 도움이 되고자 하였으며 그 결과는 다음과 같다.

1. 혈청내외 알파-퍼토프로테인의 수치는 20예 중에서 5예(25%)가 200ng/ml 이상이었다.

2. 20병소의 소형 간암중 3기가 2-3cm사이의 종양이 14예(70%)였고 1-2cm사이의 종양이 6예(30%)였으며 초음파 검사에서 저에코를 보인 것과 고에코를 보인 것이 각 6예(30%)씩이었고 혼합에코와 동일에코가 각 5예(25%) 및 3예(15%)였으며 종과의 크기에 따른 에코의 차이는 없었다. 후방에코 증강(60%), 저에코 달무리(50%), 모자이크 양상(30%) 그리고 외측그림자(5%)외 초음파 소견은 상기 빈도순으로 나타났으며 역시 종양의 크기에 따른 차이는 없었다.

3. 육안적 형태로는 팽창형이 14예(70%)로 가장 많았고 침윤성 파급형이 4예(20%)였으며 결절융합형이 2예(10%)였다.

4. 초음파에서 고에코 및 혼합에코를 보이는 경우 조직학적 검사상 응고괴사 지방변성 및 출혈의 빈도가 높았으나 간질성 섬유화와 정맥동확장은 관계없었다.

5. 피막의 형성은 16예(80%)에서 있었으며 이중에서 초음파 소견상 저에코 달무리가보였던 것은 8예였고 나머지 8예는 저에코 달무리가 보이지 않았다. 반면에 초음파에? 저에코 달무리가 있었던 것은 10예(50%)였으며 이 중 8예에서 피막 형성이 관찰되었다.

6. 종양내부에 격벽형성은 14예(70%)에서 있었으며 이중에서 6예는 초음파 소견상 모자이크 양상이 관찰되었다.

7. 후방에코 증강은 12예(60%)에서 보였으나 이와 관련된 조직학적 소견은 발견하지 못하였다.

이상의 결과로 보아 소형 간암의 초음파 소견에서 종양의 내부 에코는 저에코, 고에코, 혼합에코 및 동일에코가 종양의 크기에 따른 차이 없이 나타나고 종양의 에코를 높이는 데 관여하는 조직학적 소견은 응고괴사, 지방변성 및 출혈이었으며 저에코 달무리는 피막

형성과 유관하였다.

Small hepatocellular carcinoma : sonographic and pathologic correlation

Sun Jung Kim

Department of Medical Science, The graduate School, Yonsei University

(Directed by Associate Professor Ki Hwang Kim)

Recent advances in liver imaging such as high-resolution ultrasonography make it

possible to detect small HCC more frequently so that the incidence of curative

resection of tumor is increasing. It has bean reported that most of the small HCC

shows hypoechoic pattern in ultrasonography. As the size of tumors increases, there

are increasing tendency of hyperechogenecity and mixed echogenecity. Additional

sonographic finings of peripheral hale, posterior enhacment, lateral shadow and

mosaic pattern of the mass were reported. Sonographic features of the small HCC

will be considered to be well correlated with pathotogic features, 20 resected

lesions in 19 patients with small HCC which is less than 3cm in diameter were

evaluated for comparison of it's sonographic features with patologic features. The

results were as follows.

1. 5 patients among 19 patients had elevated serum levels of

aIpha-fetoprotein(>200ng/ml) before surgical resection

2. The size of the 14 lesions(77%) were between 2 to 3cm in diameter and 6(30%)

were between 1 to 2cm. The echogenecity of these tumors were hypoechoic in 6(30%),

hyperechoic in 6(30%), mixed echoic in 5(25%) and isoechoic in 3(15%). The

additional sonographic features were posterior enhancement (60%), peripheral ha1o

(50%), mosaic pattern (30%) and lateral shadowing (5%). The echogenecity and

additianal features of the tumors with 1-2cm in diameter were not different from

those of the 2-3cm in diameter statistically(p>0.05).

3. Pathologically expanding types were shown in 14 lesions(70%), infiltrative

spreading types in 4(20%) and nodular confluent types in 2(10%).

4. HistDlogically coagulation necrosis, fatty metamorphosis and hemorrhage were

shown frequently in hyperechoic and mixed echoic tumors. However, sinusoidal

dilatation and interstital fibrosis had no relationship with the echogenecity of

the tumors.

5. 16 lesions had fibrous capsule on pathology, however 8 of them showed

peripheral halo and the other 8 didn't show any peripheral halo. In addition 2 of

the 4 lesions without fibrous capsule demonstrated peripheral halo on

ultrasonography.

6. 7 of the 14 tumors having septum showed mosaic pattern on sonography.

7. Posterior enhancement were seen in 12 lesions, however the corresponding

pathologic changes were not found.

In conclusion, small HCC exhibited variable echo patterns and there was no

relationship between the size of tumors and the echogenecity, Coagulative necrosis,

fatty metamorphsis and hemorrhage were thought to be related to increase

echogenecity in small HCC, and also capsule is related with peripheral halo.

[영문]

Recent advances in liver imaging such as high-resolution ultrasonography make it possible to detect small HCC more frequently so that the incidence of curative resection of tumor is increasing. It has bean reported that most of the small HCC

shows hypoechoic pattern in ultrasonography. As the size of tumors increases, there are increasing tendency of hyperechogenecity and mixed echogenecity. Additional sonographic finings of peripheral hale, posterior enhacment, lateral shadow and mosaic pattern of the mass were reported. Sonographic features of the small HCC will be considered to be well correlated with pathotogic features, 20 resected lesions in 19 patients with small HCC which is less than 3cm in diameter were

evaluated for comparison of it's sonographic features with patologic features. The results were as follows.

1. 5 patients among 19 patients had elevated serum levels of

aIpha-fetoprotein(>200ng/ml) before surgical resection

2. The size of the 14 lesions(77%) were between 2 to 3cm in diameter and 6(30%) were between 1 to 2cm. The echogenecity of these tumors were hypoechoic in 6(30%), hyperechoic in 6(30%), mixed echoic in 5(25%) and isoechoic in 3(15%). The additional sonographic features were posterior enhancement (60%), peripheral ha1o (50%), mosaic pattern (30%) and lateral shadowing (5%). The echogenecity and additianal features of the tumors with 1-2cm in diameter were not different from those of the 2-3cm in diameter statistically(p>0.05).

3. Pathologically expanding types were shown in 14 lesions(70%), infiltrative spreading types in 4(20%) and nodular confluent types in 2(10%).

4. HistDlogically coagulation necrosis, fatty metamorphosis and hemorrhage were shown frequently in hyperechoic and mixed echoic tumors. However, sinusoidal dilatation and interstital fibrosis had no relationship with the echogenecity of the tumors.

5. 16 lesions had fibrous capsule on pathology, however 8 of them showed peripheral halo and the other 8 didn't show any peripheral halo. In addition 2 of the 4 lesions without fibrous capsule demonstrated peripheral halo on ultrasonography.

6. 7 of the 14 tumors having septum showed mosaic pattern on sonography.

7. Posterior enhancement were seen in 12 lesions, however the corresponding pathologic changes were not found.

In conclusion, small HCC exhibited variable echo patterns and there was no relationship between the size of tumors and the echogenecity, Coagulative necrosis, fatty metamorphsis and hemorrhage were thought to be related to increase echogenecity in small HCC, and also capsule is related with peripheral halo.