1例左下肢软骨样脂肪瘤的分析

Analysis of 1 case of chondroid lipoma of left lower limb

软骨样脂肪瘤是一种极其罕见良性肿瘤,目前有关软骨样脂肪瘤的报道少见,临床工作中易发生误诊。本文介绍1例老年男性患者,因左侧大腿后内侧有1个约7 cm×4 cm的肿物,未给予治疗后缓慢增大入院。患处皮色皮温正常无压痛,左下肢感觉、运动、血运正常。超声显示:左大腿后内侧肌内6.6 cm×3.1 cm×2.6 cm稍高回声团块,边界清楚,可见完整包膜,其内见较多纤维索条状高回声分布,肿物可见稀疏血流信号显示。MRI平扫见左侧大腿半膜肌内椭圆形异常信号影,范围约2.7 cm×3.7 cm×6.4 cm,边界清晰,其内信号略欠均匀,T1WI及T2WI高信号,T2脂肪抑制序列与T2WI信号相比出现不均匀降低,呈稍高信号,临近肌肉略受压。左侧股骨骨皮质光滑连续、信号均匀,骨髓内未见明显异常信号。MRI增强扫描显示:左大腿半膜肌内椭圆形病灶内见条片状明显强化影,病灶大部分未见强化。经手术治疗后结合病理,最终诊断为软骨样脂肪瘤。本文通过对此病例介绍及对既往文献回顾,加深对软骨样脂肪瘤的认识,旨在减少误诊发生率,避免过度治疗。

Chondroid lipoma was an extremely rare benign tumor.At present,there were few reports about chondroid lipoma,which is easy to be misdiagnosed in clinical work.In this case,an elderly male patient was introduced.He was admitted to the hospital because of a 7 cm×4 cm mass in the posterior medial side of the left thigh.This mass increased slowly after no treatment.The skin color and temperature of the affected area were normal without tenderness.The sensation,movement and blood circulation of the left lower limb were normal.Ultrasound showed that there were 6.6 cm×3.1 cm×2.6 cm slightly hyperechoic mass in the left thigh posterior medial muscle,with clear boundary and complete capsule,many fibrous cord like hyperechoic distribution and sparse blood flow signal in the mass.On plain MRI scan,there was an elliptical abnormal signal shadow in the left thigh semimembranous muscle,the range was about 2.7 cm×3.7 cm×6.4 cm,the boundary was clear,the internal signal was slightly uneven,T1WI and T2WI were high signal,T2 fat suppression sequence was slightly lower than T2WI signal,showing slightly high signal,and the adjacent muscle was slightly compressed.The cortex of the left femur is smooth and continuous,and the signal is uniform.There is no obvious abnormal signal in the bone marrow.On contrast-enhanced MRI scan,there were obvious streaked enhancement shadow in the oval lesions of left thigh semimembranous muscle,but most of the lesions were not enhanced.The final diagnosis was chondroid lipoma after operation combined with pathology.In this paper,through the introduction of this case and the review of previous literature,to deepen the understanding of chondroid lipoma,aiming to reduce the incidence of misdiagnosis and avoid over treatment.