原发性骨恶性纤维组织细胞瘤的CT、MRI表现

CT and MRI Manifestations of Primary Malignant Fibrous Histiocytoma of Bone

目的探讨原发性骨恶性纤维组织细胞瘤的CT、MRI表现。方法回顾性分析20例原发性骨恶性纤维组织细胞瘤患者的临床、CT、MRI及病理资料。结果 20例患者中,CT平扫显示16例肿瘤内均见虫蚀状、鼠咬状、地图状骨质破坏及软组织肿块;4例肿瘤未突破骨皮质。17例无明显骨膜反应,3例轻度骨膜反应。CT增强扫描显示6例肿瘤实性部分明显强化,软组织肿块内坏死、囊变区无强化。MRI平扫显示20例肿瘤均见骨质破坏,其中4例肿瘤未突破骨皮质;16例肿瘤突破骨皮质并形成软组织肿块,T1WI呈低信号或等信号,T2WI均呈混杂高信号。病理切片显示肿瘤呈灰黄、灰白相间鱼肉状,伴有出血、坏死、囊性变,并呈黏液半透明状。免疫组织化学显示17例患者的vimentin(+),CD68(+),AAT(+),AACT(+),Mac387(+)。结论原发性骨恶性纤维组织细胞瘤在临床及影像学方面缺乏特征性,应综合分析其临床及影像表现,结合病理检查及免疫组织化学标记分析,才能对原发性骨恶性纤维组织细胞瘤作出正确的诊断。

Objective To investigate the CT and MRI manifestations of primary malignant fibrous histiocytoma of bone（PBMFH）.Methods A retrospective analysis was performed on CT and MRI manifestations and clinicopathological data of 20 patients with PBMFH.Results Among the 20 patients,CT plain scan showed 16 had moth-eaten,rat-bite and map-like bone destruction and soft tissue mass,tumors did not break through the bone cortex in 4,17 had no obvious periosteal reaction,and 3 had mild periosteal reaction.Contrast-enhanced CT showed enhancement in solid tumor,necrosis in soft tissue mass and non-enhancement in cystic area in 6 patients.Unenhanced MRI showed bone destruction in 20 patients.Among the 20 patients,tumors did not break through the bone cortex in 4,and tumors broke through the bone cortex and formed soft tissue mass in 16.The mass was hypointense or isointense on T1WI and mixed hyperintense on T2WI. Pathological examination showed sallow or ashen fish-like tumors with hemorrhage,necrosis, cystic degeneration and subtransparent mucus.Immunohistochemistry showed vimentin （＋）, CD68（＋）,AAT（＋）,AACT（＋）and Mac387（＋）in 17 patients.Conclusion PBMFH is lack of special clinical and imaging characteristics.Therefore,the clinical and imaging manifestations should be analyzed and the pathological examination and immunohistochemistry should be performed to achieve a correct diagnosis of PBMFH.