摘要目的 探讨肝脏寄生虫移行症的临床、影像及病理特点.方法 收集2008年1月至2017年7月就诊于南京大学医学院附属鼓楼医院的7例行局部肝脏切除术的肝脏寄生虫移行症患者资料,对其临床资料、影像学和病理形态进行分析,结合文献进行复习.结果 男性5例,女性2例.5例以上腹部疼痛或不适为首发症状,2例为体检发现"肝占位性病变"入院.4例血嗜酸性粒细胞轻度或中度增高,术前增强CT提示肝脏不规则"串珠状"占位,动脉期无明显强化,静脉期无强化或病变周围轻度环形强化.术后病理观察发现病变均为融合性地图状的中央坏死病灶,病灶从内向外分别为彻底坏死区、坏死碎屑带、上皮样肉芽肿带和炎性细胞带.病灶内均可见大量嗜酸性粒细胞,少量多核巨细胞,并可见特征性Charcot-Leyden结晶体,其中1例见寄生虫虫体.结论 肝脏寄生虫移行症是一种少见肝脏病变,既往临床上易误诊为其他肝脏良、恶性肿瘤,结合临床资料,增强CT影像和病理检查,可以提高该病的术前和术后诊断水平.

abstractsObjective To investigate the clinical, radiological and pathological features of visceral parasitic migration of the liver. Methods Seven cases of visceral parasitic migration of liver were identified at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to July 2017. Clinical data, enhanced CT image and pathological features were analyzed, combining with literature review. Results There were 5 male and 2 female patients. Five patients presented with abdominal pain or discomfort as the first symptom. Two patients were admitted to the hospital for physical examination with liver nodule. Blood eosinophils were mildly to moderately increased in 4 cases. Enhanced CT showed the liver irregular beaded nodules that showed no significant enhancement of arterial phase. Mild enhancement of round lesions ( ring lesion) was seen in a few cases before surgery. By histopathology, the lesions showed central geographic necrosis, surrounded by epithelioid granuloma and inflammatory cell bands. A large number of eosinophils and scattered multinucleated giant cells were found, especially at the peripheral of the lesion. Charcot-Leyden crystals were present in all case and parasitic migrans was found in one case. Conclusions Visceral parasitic migration of liver is a rare liver disease and is easily misdiagnosed as other benign or malignant liver tumors. Combining clinical data, enhanced CT images and pathological examination can improve the preoperative and postoperative diagnosis of the disease.