手足部局限性腱鞘巨细胞瘤的MR表现及病理学基础

MR features and pathological basis of localized tenosynovial giant cell tumor in hands and feet

目的探讨手足部局限性腱鞘巨细胞瘤的MR表现及其病理学基础。方法回顾性分析2018年4月~2022年7月在南方医科大学第三附属医院就诊、病理证实为手足部局限性腱鞘巨细胞瘤10例患者资料,男、女各5例,中位年龄26.5岁,均行术前MR检查、术后病理学检查。由2位经验丰富的医师共同阅读MR图像,观察病变的位置、形态、大小、边界、信号特点、累及范围、强化特点及骨质改变等,并分析其病理学基础。结果10例患者,肿物发生于手部、足部者分别为6例、4例。肿块呈分叶状、条状、梭形等,边缘清晰,轴位最大径约24 mm、延伸最长径约26 mm,在T1WI上均呈低或等信号,在T2WI上呈低或等信号为主,在PDWI以高信号者为主,大部分病灶(n=8)在各序列上均见条、片状低信号,呈轻、中度不均匀强化。邻近骨质受压改变3例,骨质侵蚀1例。病理学检查提示肿块质地硬实,主要由单核细胞组成,间见含铁血黄素等。结论手足部局限性腱鞘巨细胞瘤具有相对特异的MR表现,反映其病理学特征。

Objective To investigate the MR features and pathological basis of localized tenosynovial giant cell tumor in hands and feet.Methods Ten patients with pathologically confirmed localized tenosynovial giant cell tumor in hands and feet in the Third Affiliated Hospital of Southern Medical University from April 2018 to July 2022 were retrospectively analyzed.The patients included 5 males and 5 females with a median age of 26.5 years.All patients underwent preoperative MR scanning and postoperative pathological examinations.MR findings of the lesions were analyzed by two experienced doctors,including the location,shape,size,boundary,signal intensity patterns,involvement range,enhancement patterns and bone abnormalities.The pathological basis of MR features was explored too.Results Six cases occurred in the hand and 4 cases in the feet of the 10 patients.The maximum axial diameter was about 24 mm,and the maximum extension diameter was about 26 mm.The lesions were hypo-or isointense at T1WI,mainly hypo-or isointense at T2WI,and mainly hyperintense at PDWI.Most of the lesions(n=8)showed strip or patchy hypointensity on all sequences,with mild to moderate inhomogeneous enhancement.Adjacent bone compressed was observed in 3 cases and bone eroded in 1 case.Pathological examinations showed that the masses were hard,mainly composed of mononuclear cells,and hemosiderin was seen between the cells.Conclusion Localized tenosynovial giant cell tumor in hands and feet shows relatively specific MR findings,which reflects its pathological features.