脾脏窦岸细胞血管瘤：影像表现与病理对照

Littoral Cell Angiomas of the Spleen:Imaging Features with Pathological Comparison

目的:对比分析脾脏窦岸细胞血管瘤的影像表现与病理表现,探讨脾脏窦岸细胞血管瘤的影像特征,提高对脾脏窦岸细胞血管瘤的影像学认识。材料和方法:回顾性分析5例经病理证实的脾窦岸细胞血管瘤的影像资料,结合病理表现及文献资料对其影像特征进行讨论。结果:5例病人均接受了CT平扫及增强扫描,4例有延迟扫描。2例脾肿大,4例表现为脾脏散在多发、大小不一的结节病灶,绝大多数病灶直径<2cm,1例表现为脾脏巨大肿块。CT平扫所有病灶密度与正常脾脏组织差异微小,病灶显示不清,动脉期及门静脉期病灶显示清晰,表现为边缘清晰的低密度结节或肿块,病灶部分稍有强化,延迟期病灶进一步强化、填充,密度与正常脾组织接近,病灶基本消失。1例巨块形肿块病人还接受了腹部MRI检查,病灶T_1WI显示不明显,T_2WI表现为边界清晰的低信号肿块,其中心部分有轮辐状高信号区;FSPGR动态增强扫描,病灶随着时间延迟,强化程度逐渐增强,增强早、中期中心表现为轮辐状低信号区,于延迟期病灶完全强化,其中心轮辐状低信号区域信号反而略高出周围组织信号。肿瘤病理:肿瘤都是由类似于脾窦吻合的血管腔组成,部分区域呈囊状扩张,内衬单排立方或柱状内皮上皮,细胞无异型或核分裂,可见吞噬含铁血黄素。结论:病灶延迟强化填充、MRI T_2WI低信号的特征,有助于对脾脏窦岸细胞血管瘤进行诊断和鉴别诊断。

Purpose： To demonstrate the imaging characteristics of littoral cell angiomas （LCA） of the spleen to improve the diagnostic accuracy. Materials and Methods： Five patients with pathologically confirmed splenic LCA were included, the imaging findings and pathologic appearance were analyzed, with review of the literature. Results： Four patients had multiple small nodular splenic lesions less than 2cm, the other patient had one huge mass. All loci were near iso - dense on plain CT images, after con- trast enhancement, they were well demarcated, slightly enhanced hypo - density lesions on arterial and portal phase, delayed scans of four cases showed further enhancement and iso - density of the lesions. The other huge mass underwent MR scan, T1 - weighted image showed no identifiable lesion, on T2 - weighted images it had clear margin and low signal intensity with spoke - like hyper - intensive at central area, dynamic MRI demonstrated progressed enhancement of the lesion, the central spoke - like area was enhanced and hyper - intensive on delayed images. Two patients had splenomagaly. Histologically, the tumors were composed of inosculated vascular spaces similar to the splenic sinuses with ingested hemosiderin, lined with cubital or columnlar endothelial cells without nuclear mitosis or heteromorphism. Conclusion： Progressed enhancement on delayed phase images and low signal intensity on T2 - weighted images are characteristic of splenic LCA and helpful for establishing the diagnosis.