下肢肌间弥漫性腱鞘巨细胞瘤的诊断学特征分析  

Diagnostics features of diffuse-type giant cell tumor of the tendon sheath manifestation within muscle in one lower limb

作　　者：王泽[1] 孟德华[1] 徐沁同[1] 张键[1] 

机构地区：[1]复旦大学附属中山医院骨科,上海200032

出　　处：《中华诊断学电子杂志》2016年第2期81-85,共5页Chinese Journal of Diagnostics(Electronic Edition)

摘　　要：目的探讨临床表现为下肢肌肉内孤立性病变的弥漫性腱鞘巨细胞瘤的临床诊断学特征。方法回顾性分析1例临床表现为左下肢关节外孤立性病变的弥漫性腱鞘巨细胞瘤患者的临床资料,并复习相关文献。结果患者临床表现为左下肢进行性增大的无痛性肿块,血液、生化、免疫检查等实验室检查无异常发现。超声及血流多普勒检查示左侧大腿根部实性占位,内部血流信号丰富,电子计算机断层扫描示左大腿根部实性占位,下肢磁共振检查示肌间肉瘤病灶,正电子发射断层显像/X线计算机体层成像示局部氟化脱氧葡萄糖异常浓聚。手术行包膜外正常组织内完整切除肿块,术后病理检查结合术中病灶生长方式明确为弥漫性腱鞘巨细胞瘤。结论弥漫性腱鞘巨细胞瘤可以表现为肢端孤立的关节外占位性病变,影像学检查极易因其特殊的生长方式及内部结构而倾向于恶性结果,完整的手术切除及病理学检查可以对该类病变进行治疗并明确病因。Objective To explore the diagnostic features of diffuse-type giant cell tumor of the tendon sheath manifestation with solitary mass within muscle in one lower limb.MethodsThe clinical data of one patient with diffuse-type giant cell tumor of the tendon sheath manifestation with solitary mass within muscle in one lower limb was retrospectively studied,and the relevant literatures were reviewed.ResultsThe patient presented with a progressively enlarging mass within muscle in left lower limb.Blood test,biochemical test,immunologic test showed no abnormalities.Ultrasound and Doppler scan demonstrated a solid lesion in the left thigh with rich blood supply signals inside.Computerd tomograph （CT） reconstruction images revealed a solid and homogenous mass.Meanwhile,MR test suggested a sarcomatoid change.Positive PET/CT findings showed locally abnormal accumulation of F-18 FDG,indicating a malignant lesion.Total resection around the mass with clear margin were carried out,and pathologic examination combined with growth patten of mass proved to be diffuse-type giant cell tumor of the tendon sheath.ConclusionsDiffuse-type giant cell tumor of the tendon sheath can present as a solitary extraarticular mass in limbs and is easily considered to be malignant when combined with special imaging manifestation because of its growth patten and inner constructure.Correct diagnosis and reasonable treatments can be made by pathologic examination after total resection.

关 键 词：巨细胞瘤 腱鞘软组织肿瘤 诊断 

分 类 号：R738[医药卫生—肿瘤]