胸膜外孤立性纤维瘤的影像及临床病理特征(附11例报告及文献复习)

Imaging and clinicopathological features of extrapleural solitary fibrous tumors:report of eleven cases and literature review

目的:分析胸膜外孤立性纤维瘤(Extrapleural solitary fibrous tumors,ESFT)的CT、MRI征象以及临床病理特征,提高对本病认识及诊断水平。方法:复习近年来国内外文献,回顾性分析本院经病理证实的11例ESFT的病例资料,就其临床、病理及影像诊断进行分析及总结。结果:11例中发生在腹膜后3例,大腿肌间及纵隔各2例,盆腔、臀部、肾脏及睾丸各1例;11例共13个病灶,表现为圆形或分叶形肿块,最大径约2.5~24.8 cm,12个病灶边缘清晰,1个病灶边缘不清晰。8例10个病灶CT平扫可见囊变或坏死,1个伴钙化。2例2个病灶MR平扫T_1WI为低信号,T_2WI为高低混杂信号,2个病灶均伴囊变或坏死。增强扫描9个病灶表现为动脉期中等或明显强化伴延迟强化,4个病灶表现为动脉期轻度强化伴延迟强化;6个病灶增强后显示病灶周围及内部血管影。免疫组化:bcl-2+(12/12),Vimentin+(9/12),CD34+(11/12),CD117、SMA、CK、S-100均为阴性。结论:ESFT的影像学表现有一定多样性,前瞻性诊断不易。若发现孤立性肿块,边界较清,增强扫描呈持续或延迟强化且见到迂曲血管影时,应考虑到该肿瘤的可能,确诊需要依靠免疫组化。

Objective： To analyze the CT and MRI and clinicopathological features of extrapleural solitary fibrous tumors （ESFT）, and to improve the level of recognition and diagnosis of this disease. Methods： Reviewing the literatures in recent years, 11 cases of ESFT confirmed by pathology were retrospectively analyzed, and their clinical, pathological and imaging di- agnoses were analyzed and summarized. Results： Among all the eleven cases, 3 cases were in the retroperitoneum, 2 cases in thigh and mediastinum respectively, one in hip, kidney, testis, and pelvis respectively. A total of 13 lesions were detected in 11 cases. All 13 lesions were shown as round or lobulated masses with maximum diameter ranged from 2.5 cm to 24.8 cm. Ten lesions appeared cystic degeneration or necrosis, 1 with calcification on CT, 2 lesions with cystic degeneration or necrosis had low signal on T1W1 and mixed signal on T2WI, 9 lesions showed moderate or marked enhancement in arterial phase and delayed enhancement, 4 lesions showed slight enhancement in arterial phase and delayed enhancement, 6 lesions were en- hanced to show the surrounding and internal vessels of the focus. Immunohistochemical staining results were shown as follow： bcl-2＋（12/12）, Vimentin＋（9/12）, CD34＋（11/12）, CDl17（0/12）, SMA（0/12）, CK（0/12）, S-100（0/12） were all negative. Conclusion： The imaging features of ESFT have a certain diversity, and the prospective diagnosis is not easy. If it is found that the soli- tary mass with clear boundary, enhanced scan showed continuous or delayed enhancement and see the circuitous vessels, should take into account the tumor, and the definite diagnosis needs to rely on immunohistochemistry.