胸膜孤立性纤维瘤的多层螺旋CT表现及病理对照  

Solitary fibrous tumor of the pleura:multi-slice spiral CT findings compared with pathology

作　　者：张秀兰[1] 王东[1] 樊红霞[1] 钱勇[1] 毕永民[1] 

机构地区：[1]中国人民解放军空军总医院磁共振科,北京100142

出　　处：《医学影像学杂志》2015年第10期1874-1878,共5页Journal of Medical Imaging

摘　　要：目的 探讨胸膜孤立性纤维瘤（SFTP）的MSCT表现特点。方法 回顾性分析8例经病理证实的SFTP患者的MSCT表现,观察肿瘤的部位、大小、形态、包膜、边界、密度、强化方式及程度、与周围组织的关系,并对照手术、病理学检查进行总结。8例术前均接受CT平扫及增强检查,并行MPR、MIP、VR及CTA等图像后处理。7例行手术切除,其中1例术前行穿刺活检;1例穿刺活检后未手术;8例全部经HE染色及免疫组化确诊。结果 8例SFTP,均位于胸腔,呈单发的结节或肿块,包膜完整,长径约2.7~19.0cm。4例有浅分叶,6例有瘤蒂。CT平扫8例SFTP定位明确,边界清晰,4例密度均匀,2例有囊变,1例有钙化。CT增强肿瘤血供丰富,动脉期3例较均匀强化,3例巨大肿块内多发粗大肿瘤血管,静脉期为不均匀明显强化,表现为“地图样”。CTA：3例巨大肿块供血动脉明确。镜下见梭形肿瘤细胞,周围大量胶原纤维束。免疫组化：CD34（＋）7例,1例CD34（-）,Bcl-2（＋）7例,CD99（＋）8例、CK（-）8例、EMA（-）与SMA（-）8例、S-100（-）8例,Ki-67（〈5%）8例。结论 SFTP是一种罕见肿瘤,MSCT对SFTP能准确定位,其平扫及增强表现具有一定的特征,尤其是增强动脉期粗大肿瘤血管的显示、“地图状”强化方式、静脉期明显强化及CTA供血动脉的清晰显示对SFTP的术前诊断具有重要价值。Objective To analyze the MSCT imaging features of solitary fibrous tumor of the pleura （SFTP）. Methods Eight patients with pathology-proved SFTP were retrospectively reviewed in this study. They both received plain and contrast-enhanced chest CT scans, and three-dimensional reconstruction including MPR, MIP, VR and CTA were performed before operation. 7 patiens underwent surgical resection, 1 patien received ultrasound-guided needle biopsy for diagnosis. The tumor features of position, size, morphology, capsule, boundary, intensity, degree and pattern of enhancement,relationship with the surrounding tissue,surgical outcome and histopathology were analyzed and the literature was reviewed. Results 8 cases were intrathoracic soft-tissue nodule or mass and well capsuled,maximum diameter of lesion ranged from 2.7 cm to 19.0 cm. 4 cases were lobulated, 6 cases were pedunculated. Plain CT images showed well-definded margins in 8 cases and 4 cases showed heterogeneous intensity, 2 cases showed with cystic degeneration, 1 case showed calcification. Tumors showed rich blood supply in contrast-Enhanced CT scan, 3 cases showed homogeneous enhancement at arterial phase, 3 giant mass showed inhomogeneous and strong enhancement at venous phase which was called ＂geographic pattern＂ enhancement. CTA showed feeding arteries in 3 giant mass. Microscopically, SFTP was composed of spindle cells with large collagen deposition in the intersitium. Immunohistochemical staining showed CD34 and Bcl-2 positive in 7 cases, CD34 negative in 1 case, CD99 positive in 8 cases, as well as CK, EMA, SMA and S-100 negative in 8 cases. Ki-67 showed 〈 5% in 8 cases. Conclusion SFTP has certain characteristic MSCT findings, especially tumor vascularity showed at arterial phase, ＂geographic pattern＂ enhancement, inhomogeneous and strong enhancement showed at venous phase and feeding arteries showed in CTA, which can provide important information for the diagnosis.

关 键 词：胸膜 孤立性纤维瘤 体层摄影术 X线计算机 病理学 免疫组化 

分 类 号：R734.3[医药卫生—肿瘤] R814.42[医药卫生—临床医学]