膝关节腱鞘巨细胞瘤的临床特点及影像学特征分析

Clinical characteristics and imaging featurs of giant cell tumor of tendon sheath in the knee

目的探讨膝关节腱鞘巨细胞瘤的临床、病理及影像学特点。方法回顾性分析2015年6月至2018年12月在我院经手术病理证实的19例膝关节腱鞘巨细胞瘤的临床表现、病理特点、X线、CT及MR影像学资料。结果 (1)本组19例年龄16~63岁,病程40 d^3年;14例膝关节软组织肿胀,11例膝关节疼痛,8例伴有不同程度功能活动受限,7例伴有膝关节绞索、僵硬;(2)影像显示:X线表现髌上囊饱满、软组织肿胀;CT表现膝关节不规则或结节状等密度影,髌上囊关节腔液性密度影;MR显示T1等或等低信号,T2等或稍高信号、等低信号,另外可见前交叉韧带受压(1/8)、前交叉韧带损伤(2/8)、半月板损伤(1/8)、髌腱受压(1/8)、软骨损伤(3/8)、骨髓水肿(1/8);(3)病理证实:肿瘤组织主要由单核的组织细胞样细胞、破骨细胞样多核巨细胞和黄色瘤样细胞构成,14例局限型,5例弥漫型,其中2例含铁血黄素沉积,2例出血,1例出血变性。结论膝关节腱鞘巨细胞瘤以膝关节肿胀,伴或不伴有疼痛、活动受限、关节绞索为主要临床表现,影像学检查中X、CT、MR特征与病灶部位、大小、病理成分有关,其中MR不仅可以清晰显示瘤灶的直接征象,更能显示韧带、半月板、软骨损伤,为临床诊断提供更全面、可靠的依据。

Objective To investigate the clinical,pathological and imaging features of giant cell tumor of the tendon sheath(GCTTS)in the knee.Methods To collect the clinical data of 19 patients with GCTTS in the knee confirmed by surgical pathology from June 2015 to December 2018 in our hospital,and to analyze clinical manifestations,pathological features,X⁃ray,CT and MR imaging features.Results(1)19 cases of GCTTS in the knee,the course of disease was 40 days to 3 years,14 cases of soft tissue masses,11 cases of knee pain,8 cases with varying degrees of functional limitations,7 cases with locked knee and stiffness.(2)Image displaied:X⁃ray showed full suprapatellar bursa and soft tissue swelling.CT displayed Irregular or nodular medium density shadow in the knee,suprapatellar bursa effusion.MR revealed intermediate or mild hypointensity on T1WI,whereas the features on T2WI varied and might be characterized by hypointense,isointense or hyperintense signals.In addition,anterior cruciate ligament(ACL)had been as oppressed(1/8)or injured(2/8),meniscus was injured(1/8),and patellar tendon was oppressed(1/8),cartilage defect(3/8),bone marrow was edematous(1/8).(3)Pathological confirmation:19cases of GCTTS were composed mainly by large number of mononuclear histiocytes,multinucleated osteoclast giant cells,and interstitial collagen fibroblasts composition.There were 14 cases of local type GCTTS and 5 cases of diffuse type GCTTS.2 cases of hemosiderin deposition,2 cases of hemorrhage necrosis and 1 cases of degeneration in the present study.Conclusion GCTTS in order to soft tissue swelling in the knee,with or without pain,limited mobility,and locked knee is the main clinical manifestations.Imaging features of X,CT,and MR are related to lesion location,size,and pathological components.MR can not only clearly show the direct signs of GCTTS,but also the indirect signs of display ligaments,meniscus,patellar tendon and cartilage injuries can be shown.So that,provide a more comprehensive and reliable basis for clinical diagnosis.