颅内孤立性纤维性肿瘤的影像学特征及病理学对照分析

发布时间：2018-03-02 00:30

本文关键词： 神经纤维瘤病理学体层摄影术 X线计算机磁共振成像　出处：《中国临床医学影像杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的 :探讨原发于颅内的孤立性纤维性肿瘤(Intracranial solitary fibrous tumor,ISFT)的影像学特征及病理学对照分析。方法:回顾性分析2005年1月—2015年12月我院收治的8例ISFT患者,所有病灶均经术后病理证实。行头CT平扫6例,其中4例行增强检查,全部8例均行头MR平扫及增强检查。结果:临床主要症状为头痛(5/8)。所有病例均为单发病灶,大部分位于幕上(6/8),且与脑膜关系密切。肿瘤长径3~7 cm不等(平均4.5 cm),分叶状、类圆形或不规则形。CT示肿瘤以囊实混杂为主(4/6),不均匀强化者可见迂曲血管影。MR示肿瘤边界清晰,多数瘤周无或轻度水肿(5/8)。T_1WI以等信号为主,T_2WI信号混杂,部分病灶(5/8)高低信号分界清晰。囊实混杂者明显不均匀强化,部分病灶(4/8)T_2WI低信号区可见强化。病理示瘤细胞以梭形为主,排列方式多变,细胞密集区与疏松区交替出现,间质富含血管,可见胶原、黏液样变。免疫组化示Vimentin弥漫阳性(8/8),CD34阳性率87.5%(7/8),Bcl-2阳性率75%(6/8),Ki-67 5%~20%不等。病理诊断良性4例,低度恶性2例,交界性2例。结论:ISFT通常为单发肿块,边界清晰,幕上多见,与脑膜关系密切,多以囊实混杂为主。T_2WI可特征性表现为"阴阳征",增强扫描明显不均匀强化,T2WI低信号区可见强化,仅依靠影像学诊断准确率不高,需结合病理及免疫组化。此外,部分良性病灶可恶变、复发,故应定期随访。
[Abstract]:Objective: to investigate the imaging features and pathological features of solitary solitary fibrous tumor (ISFT) in patients with intracranial solitary fibrous tumors. Methods: eight patients with ISFT from January 2005 to December 2015 were retrospectively analyzed. All lesions were confirmed by pathology after operation. Plain CT scan was performed in 6 cases, of which 4 cases were examined with enhanced CT, and 8 cases with head Mr plain scan and enhanced MRI. Results: the main clinical symptom was headache 5 / 8. All cases were single lesions. Most of them were located in 6 / 8 of supratentorial and had close relationship with meninges. The length of tumor varied from 3 to 7 cm (mean 4.5 cm / cm), lobular, round or irregular shape. Ct showed that the tumor was mainly composed of cystic and solid mixtures (4 / 6 / 6), and that in those with uneven enhancement, the boundary of the tumor was clear and tortuous. Most of the tumors had no or mild edema on 5 / 8 / T _ 1WI. The main signal intensity was iso-signal and T _ 2WI. The signal boundary of 5 / 8 / 8 of partial lesions was clear. The thickening of cyst and solid was obviously uneven, and the low signal area of 4 / 8 / 8 T _ 2WI was enhanced in some lesions. The pathological results showed that the tumor cells were mainly fusiform, and the pathological results showed that the tumor cells were mainly fusiform. The pattern of arrangement was variable, the cells concentrated area and loose area appeared alternately, the interstitial substance was rich in blood vessels, collagen and mucus like degeneration could be seen. Immunohistochemical staining showed that Vimentin diffuse positive 8 / 8 / 8% + CD34 positive rate was 87.5%. The positive rate of 75 / 8 / 8% Bcl 2 was 75 / 8% and 20% respectively. Pathological diagnosis was benign in 4 cases, and low grade malignant in 2 cases, the pathological diagnosis was benign in 4 cases and low-grade malignant in 2 cases. ConclusionTwo cases of borderline lesions are usually characterized by simple mass with clear boundary, more supratentorial, and close relationship with meninges. Most of them are characterized by "yin and yang sign" on T _ 2WI. The enhancement of hypointensity on T _ 2WI is obviously inhomogeneous on contrast enhanced scan, and it can be seen in hypointensity area on T _ 2WI. Only relying on imaging diagnosis accuracy is not high, need to be combined with pathology and immunohistochemistry. In addition, some benign lesions abominable, recurrence, so should be followed up regularly.
【作者单位】：中国医科大学附属盛京医院放射科;
【基金】：盛京自由研究者基金201402
【分类号】：R445.2;R739.41

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