Clinical Analysis Of Hepatic Dysplastic Nodule

Objective: In this study we analysed and explored the clinical features and therapeutic strategies of patients with hepatic dysplastic nodule(HDN).Methods: Total 60 cases initially diagnosed as HDN(with 14 concurrent with focal HCC)and admitted in Department of Hepatobiliary Surgery,Fourth Hospital of Hebei Medical University from January 2007 to December 2016 were retrospectively enrolled in this study.We analysed and explored the distribution of age and sex;laboratory tests included AFP and hepatitis markers;the hepatic cirrhosis;imaging examination involved CT and MRI by retrospective methods.This article focused on the epidemiological characteristics and clinical features of HDN patients.Results:1 HDN patients were more concentrated among 46-65 years(29/60),of which 18 with an average age of 51.2±2.9 years old,while 11 associated with HCC with an average age of 62.1±2.7 years old.There were significant differences(P<0.05)in the distribution of age in HDN patients.2 The total number of HDN patients was 46,and the ratio of male to female was 4.8:1,while all 14 cases associated with HCC were males.There were significant differences(P<0.05)in the distribution of sex in HDN patients.3 In this study,only one case of HDN patient with significantly increased AFP developed HCC.And 5 cases of HDN patients with mildly elevated AFP(5/14)developed HCC,while 8 cases with normal AFP(8/45).There was no significant difference(P>0.05)between the latter 2 groups.4 The incidence of cancer in the patients of HBsAg positive(14/46)was obvious higher than the HBsAg negative(0/14).There were significant differences(P<0.05)between the two groups.5 The rate of cancer in patients with liver cirrhosis(14/48)was higherthan those without cirrhosis(0/12).There were significant differences(P<0.05)between the two groups.6 On ultrasound,16 of 22 non-malignant nodules manifested as hyperechoic,while 6 of 22 were hypoechoic;only one of 8 malignant nodules was hyperechoic and 7 of 8 manifested as hypoechoic.7 On CT,22 of 32 non-malignant nodule showed slightly enhancement and 2of 32 non-malignant nodule showed not enhancement,while 9 of 10 malignant nodules manifested obvious enhancement.8 On MRI,16 of 25 non-malignant nodules showed hypointensity on T1 WI,22 of 25 showed nodules hyperintensity on T2 WI,17 of 25 nodules did not show any obvious enhancement on arterial phase and 24 of 25 manifested isointensity on DWI.While in all 4 malignant cases,nodules showed hyperintensity on T1 WI,T2WI,DWI and obvious enhancement during arterial phase.Conclusions:1 The high-risking age range for HDN is from 46 to 65 years old,and it is also a high chance to change to malignant.The number of HDN patients with HCC increased with their growing age.2 Males are more easy to get HDN,and have high risk of cancerization than female.3 There are no obvious symptoms or signs at the time of going hospital of patients with HDN.4 The sensitivity and specificity of AFP on HDN and focal cancerous are not useful in the diagnosis.5 Patients of HBs Ag positive and cirrhosis seem to have a higher risk of the occurrence of HDN and malignant transformation.6 On ultrasound,HDN tends to manifest as hyperechoic lesion;on CT,HDN mainly manifests as hypodensity during plain scanning,slight enhancement during arterial phase and isodensity during venous and delayed phase;on MRI,HDN show hypointensity on T1 WI,hyperintensity on T2 WI,not enhanced during arterial phase,isointensity during venous phase andisointensity on DWI.When nodules are hypoechoic on ultrasound,obvious enhancement during arterial phase on CT or a change of signal intensity on MRI,the nodule potentially indicates the possibility of malignant transformation.7 Considering its precancerous characteristics,it is strongly advised a surgical resection for the HDN patients,and those who are not fit for a surgery are advised a microwave ablation.The cases concurrent with HCC should be treated on principle of HCC.