摘要
目的分析恶性孤立性纤维瘤(MSFT)的CT、MRI征象以及临床病理特征,提高对该病的认识及诊断水平。方法复习近年来国内外文献,回顾性分析经病理证实的3例MSFT的病例资料,就其临床、病理及影像诊断进行分析和总结。结果3例病变部位分别在盆腔、胸腔、脑部,表现为圆形或分叶形肿块,最大径约108 mm,2例边缘不清晰,1例边缘清晰。2例病灶CT平扫可见囊变或坏死,1例伴钙化。1例MRI平扫T1WI为低信号,T2WI为高低混杂信号。增强扫描2个病灶表现为动脉期明显强化伴延迟强化,1个病灶表现为动脉期轻度强化伴延迟强化。3个病灶增强后显示病灶周围及内部血管影。2例出现术后转移。免疫组化:CD34+(3/3),Bcl-2+(3/3),Vimentin+(3/3),CD99+(2/3),Ki-67+(3/3),S-100+(1/3),Desmin、CK、SMA均为阴性。结论MSFT的影像学表现有一定多样性,前瞻性诊断不易。若发现病灶体积较大,形态不规则,边界不清,信号或密度不均匀,呈侵袭性生长,增强扫描呈持续或延迟强化且见到迂曲血管影时,应考虑到MSFT的可能,病理学及免疫组织化学诊断是确诊MSFT的金标准。
Objective To analyze CT,MRI and clinicopathological features of maligant solitary fibrous tumor(MSFT)for improving the recognition and diagnosis of the disease.Methods Home and abroad literature in recent years were reviewed and 3 cases of MSFT confirmed by pathology were finally picked and retrospectively analyzed in their clinical,pathological and imaging diagnosis.Results The lesions were located in the pelvic cavity,thoracic cavity and brain,showing round or lobulated masses with a maximum diameter of 108 mm.2 cases had ill-contours,whereas 1 showed well-defined contours.Cystic degeneration or necrosis in 2 cases and calcification in 1 were observed via CT plain scan.Low signal on T1WI and mixed signal on T2WI 1 lesions were found in 1 case with cystic degeneration or necrosis;2 lesions showed marked enhancement in arterial phase and delayed enhancement,yet slight enhancement in arterial phase and delayed enhancement in 1 case were observed via enhanced scan.Focus around and inside the vessels was found in 3 cases after being enhanced and postoperative metastasis was observed in 2 cases.Immunohistochemical staining results were shown positive in CD34+(3/3),Bcl-2+(3/3),Vimentin+(3/3),CD99+(2/3),Ki-67+(3/3),S-100+(1/3),and Desmin,CK and SMA were all negative.Conclusion The imaging manifestations of MSFT are diverse so it’s not easy to prospectively diagnose.Based on histopathology and immunohistochemical examinations,the possibility of MSFT should be considered in case of a large size of lesions,irregular shape,unclear boundary,uneven signal or density,invasive growth,continuous or delayed visible tortuous vascular shadow.
作者
卢德伟
黄德尤
LU Dewei;HUANG Deyou(Department of Radiology,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China)
出处
《右江医学》
2020年第2期105-110,共6页
Chinese Youjiang Medical Journal
基金
右江民族医学院附属医院(临床医学院)临床医学博士学位授予点学科建设项目(右医附院院字[2018]29号)
