骨盆原发性肿瘤及肿瘤样病变的影像诊断

Imaging Diagnosis of Primary Pelvic Tumors and Tumor-like Lesions

目的分析骨盆原发性肿瘤及肿瘤样病变病理类型、临床表现及影像学特点。方法 18例骨盆原发性肿瘤及肿瘤样病变均经病理穿刺或手术证实,术前均行X线检查、CT和/或MRI检查,结合病理回顾性分析其临床表现及影像学。结果骨盆原发性肿瘤及肿瘤样病变以恶性多见(13例),其中以骨髓组织来源最多见(7例):淋巴瘤(4例)、尤文氏肉瘤(3例),其次高分化软骨肉瘤(2例),骨肉瘤(1例),横纹肌样瘤(1例),腺泡状软组织肉瘤(1例),侵袭性纤维瘤(1例);临床病程短(10余天-6个月)或急性加重(1年余-3年,急性加重10余天-5个月);影像学表现包括骨质破坏、软组织肿块、瘤内钙化灶、骨针等。良性病变(5例),以肿瘤样病变多见:孤立性骨囊肿(3例),软骨母细胞瘤(1例),软骨粘液样纤维瘤(1例);临床病程长(8月余28年),加重时间长(4月余-3年);X线平片上表现为局限性骨质密度减低、边界较清、退行性变或未见异常,较少行CT或MRI检查。结论骨盆原发性肿瘤及肿瘤样病变病类型理复杂,恶性多见,结合临床病程及影像学表现能较准确定良恶性。

Objective To describe the pathologic of primary pelvic tumors and tumor-like lesions types, clinical and imaging characteristics Methods The histopathology types of the 18 primary pelvic lesions were all obtained by operation or biopsy. Routine radiographic film, CT and/or MR were analyzed in all cases retrospectively. Results Among all 18 primary pelvic lesions, histopathology revealed the most were malignant tumors（13/18）. The first were from bone marrow（7cases）：Ewing sarcoma （3cases）and lymphoma（4cases） while the second were chondrosarcoma（2 cases）,osteosarcoma （1 cases）,striated muscle- like tumor（1 case）, alveolar soft part sarcoma（1 case）, aggressive fibroma （1 case）. Clinical course were short or acutely aggravating. Image manifestations contained soft tissue mass, bone destruction, calcification and skeletal spicules. The benign lesions were bone cysts （3/ 5）, chondroblastoma （lcase） and chondromyxoid fibroma-like osteosarcoma （lcase）. CT or MRI examinations were used less. The image features were also revealed. Conclusion To diagnose primary pelvic tumor and tumor-like lesions correctly need combine the different image instruments and analyze the image manifestations synthetically due to the complicated histopathology of tumors.