腹盆部孤立性纤维瘤的CT、MRI表现与临床病理分析

CT and MRI of Solitary Fibrous Tumor in the Abdomen and Pelvis with Pathologic Correlation

目的分析腹盆部孤立性纤维瘤(SFT)的CT、MRI征象以及临床病理特征,以期提高对本病的诊断水平。方法回顾性分析经手术病理证实的15例腹盆部SFT患者资料,总结其临床、病理及影像学特点。结果15例中,累及腹腔、腹膜后、盆腔者各3例;肾受累2例,胃、膀胱、直肠、肠系膜受累各1例。肿块形态为圆形12例,分叶形3例。最大径约1.7~17.9 cm。肿块边界清晰13例,不清晰2例。15例均行全腹部CT平扫,10例肿瘤密度不均匀,瘤内均未见出血及钙化;CT增强扫描12个病灶表现为动脉期中等或明显强化,3个病灶表现为动脉期轻度强化;7个病灶增强后可见瘤周及内部迂曲血管影。4例行MRI平扫,T1WI为等低信号,T2WI为混杂信号,内均可见囊变坏死区;MRI增强扫描呈中等或明显强化伴延迟强化。病理:肿瘤细胞多为短梭形,排列不规则。免疫组织化学:Bcl-2(+)14例,Vimentin(+)12例,CD34(+)15例,CD99(+)13例,SMA(+)1例,Desmin(+)1例,CD117、CK、S-100均为阴性。随访过程中,2例巨大肿瘤复发。结论腹盆部CT或MRI若发现边界较清晰的孤立性肿块,增强扫描明显或中度强化伴延迟,并可见到多发迂曲血管影时,应考虑到SFT的可能,确诊依靠病理及免疫组织化学,治疗方法主要为手术切除,术后应该终身随访。

Objective To analyze the CT,MRI and clinicopathologic features of solitary fibrous tumor(SFT)of the abdomen and pelvis.Methods The data of 15 cases confirmed by surgery and pathology were retrospectively analyzed.Their clinical,pathological,MSCT and MRI data was summarized.Results Among the 15 patients,3 were in the abdominal cavity,3 in the retroperitoneum,1 in the stomach,2 in the kidney,3 in the pelvic cavity,1 in the bladder,1 in the rectum,and 1 in the mesentery.The shape of the mass was round in 12 cases and lobulated in 3 cases.The maximum diameter is about 1.7~17.9 cm.The boundary of tumor was clear in 13 cases and unclear in 2 cases.CT plain scan showed non-uniform density in 10 cases and no bleeding or calcification was found in the tumor.CT enhancement scanning showed moderate or obvious enhancement in 12 lesions in the arterial phase,and mild enhancement in 3 lesions in the arterial phase.Peritumor and internal tortuous vascular images were seen in 7 lesions after enhancement.In the 4 cases,T1WI and T2WI showed equal low signal and mixed signal on MR plain scanning.MR enhancement scanning showed moderate or significant enhancement with delay.Pathology:Most of the tumor cells were short,fusiform and arranged irregularly.Immunohistochemical:bcl-2+(14/15),Vimentin+(12/15),CD34+(15/15),CD99+(13/15),SMA+(1/15),Desmin+(1/15),CD117、CK、S-100 were all negative.During follow-up,2 cases of giant tumors recurred.Conclusion If an isolated mass with a clear border is found in the abdomen and pelvis,obvious or moderate enhancement with delay in the arterial phase of the enhanced scan and multiple tortuous vascular shadows are visible,the possibility of the tumor should be considered,and the diagnosis depends on pathology and immunohistochemistry.The main treatment method is surgical resection,and postoperative follow-up should be lifelong.