原发性脾血管肉瘤的CT和超声及病理对照研究  

A correlative study of CT,ultrasound and pathology in primary splenic angiosarcoma

作　　者：蒋诚诚[1] 滕跃[1] 董凤林[2] 刘卫硕[3] 李勇刚[1] 

机构地区：[1]苏州大学附属第一医院放射科,江苏215006 [2]苏州大学附属第一医院超声影像,江苏215006 [3]苏州大学附属第一医院病理科,江苏215006

出　　处：《放射学实践》2017年第6期639-642,共4页Radiologic Practice

摘　　要：目的:探讨原发性脾血管肉瘤(PSA)的超声、CT表现及病理特点。方法:回顾性分析2005年-2015年经手术及病理证实的7例PSA的临床、CT及超声表现,并与病理结果进行对照研究。结果:7例PSA的影像学表现可以分为3型,Ⅰ型为单发病灶(n=1),CT平扫呈类圆形稍低密度灶,增强扫描边缘强化;脾脏病灶超声呈类圆形低回声。Ⅱ型为多发、分离病灶(n=5),其中平扫4例表现为稍低密度,其中3例超声检查,1例表现为低回声、回声不均,1例病灶表现为高低混杂回声,1例未发现明确病灶,增强CT扫描4例为边缘强化,1例表现为结节状强化。Ⅲ型为弥漫性病变(n=1),平扫为多发大小不等类圆形稍低密度,增强部分边缘强化,部分结节状强化;超声表现为脾大,回声粗。病理表现4例为弥漫性、不典型的血管内皮细胞蜂窝状或海绵状排列,2例镜下见裂隙血管及乳头状结构,1例表现为纺锤状的内皮细胞增殖排列形成血管间隙。结论:PSA的临床特点、影像学及病理表现有一定的特异性,认识其影像学及病理特征对减少误诊有重要意义。Objective：To study the CT findings,ultrasonic manifestations and pathological characteristics of primary splenic angiosarcoma （PSA）. Methods： The clinical data,CT findings and ultrasonic manifestations of 7 cases of PSA con- firmed by surgery and pathology were retrospectively analyzed and correlative study with pathological results from 2005 to 2015 in our hospital was performed. Results：The imaging findings of the 7 cases varied and could be divided into 3 types. In type 1 （n： 1）,there was single lesion with low density and marginal enhancement on CT, and low echo on ultrasound. In type 2 （n= 5） these were multiple scattered lesions, of which 4 cases were hypodeuse on CT. Contrast-enhanced CT showed marginal enhancement in 4 cases and modulal enhancement in one case. 3 cases of them received US, of which one case showed low echo,one case showed heterogeneous echo, and one case showed no evidence of abnormity within spleen. In type 3 （n= 1） these was difference lesion,appearing irregular and hypodense on plain CT, pantial marginal enhancement and nod- ular enhancement on contrast-enhanced CT, and heterogeneous echo within enlarged spleen on metrasound. The pathological performances varied. 4 cases showed honeycomb or spongeqike patterns lined with irregular endothelial cells. In 2 cases, pa- pillary structures of proliferating tumor cells were observed protruding into vascular lumina and cystic spaces,and solid pro- liferation of spindle-shaped epithelioid ceils was also seen in 1 ease. Conclusion： The clinical characteristics, imaging and pathological features of PSA are characteristic in a certain extent. It is very important to identify the imaging and pathology features of PSA to reduce the misdiagnosis.

关 键 词：血管肉瘤 体层摄影术 X线计算机 超声成像 病理学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R733.2[医药卫生—临床医学]