上皮样肉瘤CT和MRI表现及其病理基础  

Epithelioid Sarcoma:CT and MRI Findings with Corresponding Pathological Basis

作　　者：余洪[1] 吴博[1] 刘衡[1] 柏永华[2] 骆科进[1] 李邦国[1] 张体江[1] 

机构地区：[1]遵义医学院附属医院影像科,贵州省医学影像中心,贵州遵义563003 [2]遵义医学院附属医院病理科,贵州遵义563003

出　　处：《临床放射学杂志》2016年第6期964-968,共5页Journal of Clinical Radiology

摘　　要：目的探讨上皮样肉瘤(ES)的CT、MRI表现及其病理基础。方法回顾性分析5例经手术病理证实的ES的CT、MRI和病理学表现。结果 5例ES中,发生于左前臂、左足、右眼眶、左外耳道、左侧阴茎根部各1例。3例行CT扫描,2例呈类圆形,1例呈铸状。1例边界清楚,1例部分边界不清,侵犯周围组织。CT平扫密度均不均匀,伴有斑片状低密度区,其中1例为囊实性肿块;增强扫描肿块不均匀强化,1例边缘及分隔轻度强化,1例中度渐进性强化;1例体积较小,密度均匀。其中2例行MRI扫描,T_1WI:2例病灶以等信号为主,1例病灶内见稍高信号区;T_2WI:2例病灶呈高信号为主混杂信号,1例病灶内见少量斑片状等或低信号,MRI增强扫描病灶呈不规则环状强化,内有斑片状坏死区无强化。免疫组织化学:Vimentin阳性率100%(5/5),CK阳性率80%(4/5),EMA阳性率100%(3/3),CD34阳性率50.0%(2/4),HMG45阴性率100%(5/5),S-100阴性率75.0%(3/4),SMA阴性率66.7%(2/3),CD31阴性率50.0%(1/2)。结论 ES的CT和MRI表现均有一定的特点,单发或多发,边界不清,CT平扫密度不均匀,增强扫描不均匀轻到中度强化,边缘条状或片状强化;MR T_1WI呈均匀等信号,T_2WI呈混杂高信号,增强扫描呈不均匀显著强化。Objective To analyze the CT and MRI findings of epithelioid sarcoma（ES） and to improve the understanding and diagnostic ability prior to surgery.Methods CT,MRI and pathological findings were retrospectively reviewed in 5 patients with ES proved by operation and pathology.Results The tumors were respectively found in left forearm,right foot,right orbit,left external auditory canal,and penis with 1 case.Three cases were found on CT scan,among which there were 2 cases presented with round mass,1 lesion with clear boundary,the other with partially unclear and invasive margin.The remaining 1 case presented with irregular mass.2 tumors showed heterogeneous masses with patchy,necrotic foci,among which 1 case was cystic with solid mass.Contrast enhanced CT images showed heterogeneous enhancement,mild enhancement of edge and separation was observed in one tumor,the other demonstrated moderate enhancement,1 case of small size with homogeneous without enhanced CT.On unenhanced MRI,the lesions presented isointensity on T_1WI,mixed hyperintensity on T_2WI in 2 lesions,1 case showed a small patch of hypointensity on T_2WI.On contrast enhanced MRI demonstrated irregular ring enhancement with central multinecrosis being hypointensity.Immunohistochemical staining showed that Vimentin positive was 100.0%,CK（80.0%）,EMA（100%）,CD34（50.0%）,as well as negative HMG45（100%）,S100（75.0%）,SMA（66.7%） and CD31（50.0%）.Conclusion CT and MRI findings of ES have certain characteristic findings,single or multiple,illdefined margins,on plain CT scan,density is heterogeneous,enhanced CT scan showed mild to moderate enhancement,edge strip or patchy enhancement; enhancement MRI scanning demonstrated significant inhomogeneous enhancement.

关 键 词：上皮样肉瘤 体层摄影术 X线计算机 磁共振成像 病理学 

分 类 号：R730.26[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44