原发性肺滑膜肉瘤的影像表现与病理分析

Imaging Findings and Pathological Analysis of Primary Pulmonary Synovial Sarcoma

目的探讨原发性肺滑膜肉瘤(PPSS)的影像表现及病理特征。方法回顾性分析7例经术后病理证实原发性肺滑膜肉瘤,并结合国内外文献报道,总结该病的临床、影像及病理特征。结果7例PPSS,其中男3例,女4例,平均年龄49.9岁,7例行CT检查:3例呈类圆形,2例呈巨大不规则形,2例呈“铸形”、“指状”;3例病变密度均匀,4例肿块密度不均匀,伴坏死、液化区;增强呈不均匀轻中度强化;较少伴纵隔、肺门淋巴结转移,可伴同侧胸腔积液。1例行MRI检查:T1WI呈中等略低信号,T2WI呈中等略高信号,内见更高T2WI信号,DWI呈不均匀稍高信号,增强呈轻中度强化。分子病理学检查:由梭形细胞或上皮性细胞组成。3例SYT基因存在断裂异位。结论PPSS具有一定的影像特征,确诊仍需病理确诊,但影像学检查对明确肿瘤的定位、数目、是否侵犯和转移,明确手术可切除性和后期随访等,为临床提供重要的参考价值。

Objective To investigate the imaging and pathological features of primary pulmonary synovial sarcoma.Methods Seven cases of primary pulmonary synovial sarcoma confirmed by postoperative pathology were analyzed retrospectively,and the clinical,imaging,and pathological features of the disease were summarized.Results Among the 7 cases of PPSS,3 males and 4 females,with an average age of 49.9 years.CT examination of 7 cases displayed that 3 cases showed quasi-round shape,2 cases showed huge irregular shape,2 cases showed“casting shape and finger shape,”3 cases showed homogeneous density,4 cases showed inhomogeneous density with necrosis and liquefaction area,inhomogeneous enhancement was mild to moderate enhancement,less with mediastinal and hilar lymph node metastasis,but with ipsilateral pleural effusion.One case of MRI examination displayed that T1WI showed moderate and slightly low signal intensity,T2WI showed moderate and slightly high signal intensity,higher T2WI signal was seen,and DWI showed inhomogeneous slightly higher signal intensity mild to moderate enhancement.Pathological examination:it was composed of spindle cells or epithelial cells.3 cases of SYT gene were ectopic.Conclusion PPSS had certain imaging features,which still need to be confirmed by pathology,but imaging examination could provide an important reference value for clinical diagnoses,such as tumor location,number,invasion and metastasis,surgical resectability,and follow-up.