恶性胸膜孤立性纤维瘤的临床CT分析

CT feature and clinical findings of malignant solitary fibrous tumor of the pleura

目的探讨恶性胸膜孤立性纤维瘤的临床特点及CT征象。方法回顾性分析11例经手术病理证实的恶性胸膜孤立性纤维瘤的临床及CT资料。结果临床表现为咳嗽、咳痰、气促、胸痛及胸闷8例,3例为体检时偶然发现。11例CT上均表现为胸腔单发软组织密度肿块,肿瘤最长径5~17cm,平均(10.9±4.6)cm;11例密度均不均匀,部分呈"地图样"改变,2例瘤内见钙化,6例瘤内见增粗扭曲血管影,1例见右侧膈下动脉发出异常供血血管进入肿块。11例均可见肿瘤周围肺组织压迫不张,2例纵隔结构受压向对侧移位。2例边缘毛糙,并见邻近胸膜增厚,其中1例邻近肋骨骨质破坏、胸壁肌肉受侵犯,5例见微量至中等量胸腔积液。结论恶性胸膜孤立性纤维瘤患者多有临床症状,肿瘤体积较大,内部密度不均匀,瘤内血管丰富,合并胸水多见,CT表现有一定特征性,有助于术前诊断。

Objective To evaluate the CT characteristics and clinical findings of malignant solitary fibrous tumor of the pleura （SFTP）. Methods The clinical symptoms included cough, expectoration, shortness of breath, chest tightness or chest pain in 8 cases, and 3 cases were incidentally found during physical examination. CT features and clinical data of 11 patients with malignant SFTP confirmed by pathology after operation were analyzed retrospectively. Results The CT images demonstrated solitary soft-tis- sue mass in the thoracic cavity, with the largest diameter being 5 to 17 cm. Attenuation was heterogeneous in all the cases. In-tralesional calcification or serpiginous vessels were seen in 2 and 6 cases respectively,and feeding vessel originated from right in-ferior phrenic artery was shown in 1 ease. hTegular pleura thiekening （ n = 2） and rib erosion （ n = 1 ） were also seen. Conclu- sion Malignant SFTP shows certain charaeteristies on CT, whieh helps to preoperative diagnosis.