胸部孤立性纤维瘤的临床及影像学特点分析

Analysis on the clinical and imaging feature of thorax solitary fibrous tumor

目的探讨经术后病理证实的胸部孤立性纤维瘤的临床及影像学特点。方法回顾性分析16例经病理确诊的胸部孤立性纤维瘤患者资料,平均年龄45.2岁,所有患者术前经电子计算机断层扫描(CT)等影像学检查及气管镜检查均未能确诊。结果本组患者中2例因肿瘤巨大产生肺不张症状,2例出现非特异性胸痛,其余均无特异性症状。术前诊断神经源性肿瘤、肺癌、胸腺瘤、肺隔离症、错构瘤及间皮瘤,误诊率为62.5%,CT下最大径多位于脏壁层胸膜位置,与相对胸膜之间有低密度条带影,且成锐角,形状多为半球形及梭形,边缘光滑,边界清楚,瘤体直径1~21cm,平扫32.9HU,多不均匀强化,强化值64.5HU,位于肺外或以细蒂与之相连,所有手术均顺利完成,无严重术后并发症和死亡发生。术后病理均明确诊断为胸部孤立性纤维瘤,确诊率100%;其中细胞增生活跃11例。结论胸部孤立性纤维瘤是比较少见的胸腔内良性肿瘤,临床影像学表现具有一定特点,对于位于脏壁层胸膜位置的边界清楚、边缘光滑的软组织密度肿物,尤其是最大径位于胸膜位置,且与之有低密度条带影相隔的需考虑该诊断可能,多数有恶性潜能,一经发现需积极治疗。

Objective To investigate the clinical and imaging feature of thorax solitary fibrous tumor confirmed pathologically. Methods Retrospectively analysed 16 patients with thorax solitary fibrous tumor pathologically confirmed, the average age was 45.2 years, all the patients could not be diagnosed preoperatively by computer tomography(CT) or other imaging examination or bronchoscopy. Results 2 cases developed pulmonary atelectasis symptoms because of large tumors, 2 cases developed non-specific chest pain, other patients had no specific symptoms. Preoperative diagnosis was neurogenic tumors, lung cancer, thymic cancer, pulmonary sequestration, hamartoma, misdiagnosis rate was 62.5%, CT showed the maximum diameter were mostly located in visceral pleura. There were low density strips between the adjacent parietal pleura, usually form acute angles against adjacent pleural surfaces, mostly hemispherical shape and form spindle with smooth edge and clear boundary, tumor diameter was from 1 to 21 cm, unenhanced scan was 32.9HU, mostly heterogeneously enhanced, strengthening value was64.5HU, located extrapulmonary or connected fine pedicle, all operations were successfully completed, no serious complications or operative mortality. Pathological diagnosis confirmed thorax solitary fibrous tumor, diagnosis rate was 100%; 11 cases of them had cell hyperplasia. Conclusion Thorax solitary fibrous tumor is a relatively rare benign chest tumor, clinical imaging had certain characteristics, for pleura located, clear boundary, edge smooth, soft tissue density mass, especially the largest diameter located in the pleura position and with low density strips between the adjacent parietal pleural, the diagnosis of thorax solitary fibrous tumor should be considered, aggressive surgery is recommended due to malignant potential.