腹内硬纤维瘤的CT表现与病理对照研究

The Comparative Study of CT and Pathology in Intra-abdominal Desmoid Tumors

目的：探讨腹内硬纤维瘤（DT）的cT表现及病理学特征。材料和方法：回顾性分析lO例经手术病理证实的腹内DT的cT表现，并与病理进行对照分析。结果：10例腹内DT中，位于腹腔6例，腹膜后4例。肿瘤最长径4．3～17．1cm。4例DT形态不规则，6例呈椭圆形；5例边界清楚，5例边界不清或部分不清；3例可见完整或部分包膜。10例均行cT平扫加增强检查，平扫3例密度均匀，7例密度不均匀，其中1例可见不规则出血灶，所有病灶内均未见坏死及钙化，肿瘤密度均低于髂腰肌密度；增强扫描10例动脉期均呈轻度不均匀强化，门脉期呈渐进性强化。病理：镜下梭形纤维母细胞呈束状、编织状排列，无明显异型性，核分裂罕见，呈浸润性生长，伴胶原纤维增生及粘液样变。免疫组织化学：Vimentin阳性率100％（10／10），CD34、S-100阴性率均为90％（9／10），CDll7阴性率100％（10／10），SMA阴性率80％（8／10）。结论：腹内DT的CT表现具有一定的特征性，对该肿瘤的诊断和鉴别诊断有一定的意义。

Objective： To investigate the CT imaging and pathology features of intra-abdominal desmoids tumors （DT）. Methods： CT imaging features of l0 cases with intra-abdominal DT proved by pathology were retrospectively reviewed and compared with pathological results. Results： Among the l0 cases, 6 cases were located in the abdominal cavity and 4 cases in the retroperitoneum. The maximum tumor size ranged from 4.3 to 17.1 cm. 4 cases were irregular and 6 cases were ellipse. 5 tumors had well-defined contours, the other 5 cases showed ill-defined contours. 3 cases showed complete or incomplete encapsulation. All the l0 cases underwent CT plain and enhanced scan. On CT plain imaging, the lesions showed homogeneous density in 3 cases, the others showed heterogeneous density, one of which had flaky hemorrhage. There was no necrosis or calcification in all lesions. All the tumors showed lower density than iliopsoas. On CT enhanced scan, l0 lesions presented slight heterogeneous enhancement in the arterial phase and continuous enhancement in the venous phase. Under the microscope, the spindle fibroblasts were bunchy distribution with no obvious heteromorphism and rare karyokinesis. The collagen fibers showed proliferation and mucinous degeneration. Positive immunohistochemical staining： Vimentin 100% （10/10）. Negative immunohistochemistry staining： CD34 90% （9/10）, S- 100 90% （9/l 0）, CDI17 100% （10/10）, SMA 80% （8/10）. Conclusion： Intra-abdominal DT has characteristic features on CT imaging and plays an important role in the diagnosis and distinction between DT and other tumors in abdomen.