骨良性纤维组织细胞瘤的影像学表现及与病理对照分析

Imaging manifestations of benign fibrous histiocytoma of bone:Comparison with pathological features

目的探讨骨良性纤维组织细胞瘤(BFH)的影像学表现及其病理学特点。方法回顾性分析经手术及病理证实的19例骨BFH患者的影像学资料,并与相应病理结果进行对照。结果 19例均接受X线检查,15例接受CT检查,17例接受MR检查。X线平片BFH表现为不同程度膨胀性骨质破坏,病灶呈单房或多房状,骨皮质变薄。CT示BFH病灶边界相对清楚,周围可见硬化边,其内见不连续的骨性分隔,CT值0~75 HU,其中2例病灶中心可见新生骨。MR检查显示5例病灶T1WI呈等低信号,T2WI及快速反转恢复序列(TIRM)呈高信号;8例T1WI以等低信号为主,其间夹杂散在斑点状稍高信号,质子密度加权像(PDWI)及T2WI呈高低混杂信号;4例T1WI及T2WI呈索条或斑片状低信号。术中见瘤体为黄褐色肉芽组织,镜下见5例BFH病灶以大量组织细胞为主;8例组织细胞、泡沫细胞、成纤维细胞混杂存在;4例以大量成纤维细胞为主;2例见大量新生骨小梁。结论骨BFH影像学表现有一定特征,与其病理学特点相对应。

Objective To explore imaging manifestations of benign fibrous histiocytoma（BFH）of bone compared with relative pathological features.Methods Imaging data of 19 patients with BFH of bone proved by pathology were retrospectively analyzed compared with pathological findings.Results X-ray plain films were obtained in 19 patients,while CT scan in 15 patients and MRI in 17 patients.X-ray films showed different degrees of cystic expansive destruction of bones,the lesions might be single cystic or multilocular,and the cortex of bone became thinned.CT showed that the lesions were well-demarcated and had sclerosis margins,and the discontinuous bony septum could be found within the lesions.Bony patches at the center of the lesion were detected in 2 patients.Hypo-or iso-intensity on T1WI and light hyper-intensity on T2WI or turbo inversion recovery magnitude（TIRM）images were observed in 5 patients.Mainly lowintensity signals,with slightly scattered signals on T1 WI and low to high mixed signal on T2WI or proton density weighted image（PDWI）were found in 8 patients.Hypo-or iso-intensity on,and striped or patched hypo-intense signal on T1WI or T2WI were shown in 4 patients.Intraoperative observation showed the tumors were composed with yellowish brown granulation tissue,and microscope displayed a large number of histiocytes in 5 patients,mixed with histiocytes,foam cells and fibroblasts,accompanied by small amounts of inflammatory cells in 8 patients,a large number of spindles form fibroblasts mainly in 4 patients.A lot of trabeculae were found in 2 patients.Conclusion Bone BFH has certain imaging characteristics which corresponded with different pathological characteristics.