脾脏硬化性血管瘤样结节性转化的影像表现及其病理基础  

Spleen sclerosing angiomatoid nodular transformation：imaging findings with pathological correlation

作　　者：谭延斌[1] 方圣伟[1] 胡婷婷[1] 赵祖丹[1] 耿艳华[2] 张敏鸣[1] 

机构地区：[1]浙江大学医学院附属第二医院放射科,浙江杭州310009 [2]浙江大学医学院附属第二医院病理科,浙江杭州310009

出　　处：《实用放射学杂志》2013年第10期1613-1616,共4页Journal of Practical Radiology

摘　　要：提高对脾脏硬化性血管瘤样结节性转化（SANT）影像表现的认识及诊断准确率。方法 对经手术病理证实的4例SANT进行回顾性分析,讨论影像表现及其病理基础。结果 4例SANT中,2例误诊为脾错构瘤,1例误诊为血管瘤,1例误诊为转移瘤。影像学表现为：（1）CT平扫均呈稍低密度3例,边界2例清楚,1例边界不清,动态增强扫描后呈渐进性强化模式,中央见点状及条状无强化或轻度强化区。（2）MRI表现1例,平扫T1WI为等信号影,T2WI为周边稍高信号中央点状低信号,动态增强扫描后呈渐进性强化模式,病灶强化程度较周围脾组织稍高,中央可见点状无强化区。病理特点为肿瘤由多个大小不一的血管瘤样结节构成,结节中央可见裂隙样或窦样血管腔,结节周围围绕着致密的向心性分布的梭形细胞。结论 虽然SANT 的影像学表现尤其是动态增强强化方式具有一定特征性,然而单纯依靠影像学表现做出诊断仍然比较困难。最终大多数患者确诊还需术后的病理学明确。Objective To improve diagnostic accuracy of spleen sclerosing angiomatoid nodular transformation （SANT） by analyzing its imaging findings. Methods 4 cases of pathohistologieally proved SANT were retrospectively analyzed. Their imaging find ings and pathologic results were discussed. Results Among these 4 cases of SANT, 2 cases were misdiagnosed as spleen hamartoma presurgery, 1 case was misdiagnosed as spleen hemangioma, and 1 case was misdiagnosed as spleen metastatic tumor. The main im- aging findings were as follows： （1）non-enhance CT scan showed slightly hypodense area in 3 cases, while the dynamic enhanced CT scan showed progressive enhancement mode, with punctuate and strip no enhancement or slightly enhancement area in the center. The boundary of these masses were defined （2 cases） or undefined （ 1 case）. （2）MRI scan of 1 case showed isointensive lesion in T1WI, peripheral hyperintensity with central punctuate hypointensity area in T2WI, which had the progressive enhancement mode after the dynamic enhanced scan. The degree of mass enhancement was slightly higher than normal spleen with punctuate no enhancement in the central area. The corresponding pathological findings showed the lesions were primarily composed of muhiple angi- omatoid nodules which had fissure like or sinus-like vascular lumen in the center and dense concentric distribution fusiform shape cells around. Conclusion The imaging findings of SANT had some characteristics, especially the dynamic enhancement mode. However, it is still difficult to make diagnosis based on the imaging features alone. Most patients require splenectomy to make a definite pathologic diagnosis at last.

关 键 词：脾脏 血管瘤样 结节性转化 

分 类 号：R733.2[医药卫生—肿瘤] R814.4[医药卫生—临床医学]