胸膜孤立性纤维瘤的影像学及病理学分析  

Solitary fibrous tumors of the pleura: radiologic and pathologic findings

作　　者：张丽萍[1] 唐秉航[1] 李良才[1] 何亚奇[1] 吴任国[1] ZHANG Liping;TANGBinghang;LI Liangcai;HE Yaqi;WU Renguo(Department of CT, Zhongshan People’s Hospital,Zhongshan 528403, Guangdong Province, Chin)

机构地区：[1]广东省中山市人民医院CT室,广东中山528403

出　　处：《肿瘤影像学》2018年第2期109-113,共5页Oncoradiology

摘　　要：目的:探讨胸膜孤立性纤维瘤(solitary fibrous tumor of the pleura,SFTP)的影像学特征,以提高对该病的认识。方法:回顾性分析经手术病理证实的15例SFTP患者,13例行CT平扫及增强检查(其中1例同时行MRI检查),另外2例仅行MRI检查。分析肿瘤大小、形态、密度或信号、强化方式及其与周围结构的关系。结果:15例均为边界清晰的孤立性肿块,10例呈类圆形或椭圆形,5例呈分叶状。CT平扫以等密度为主,密度均匀或不均匀。2例内见钙化。MRI T1WI呈等低信号,T2WI呈等偏高信号,扩散加权成像(diffusion weighted imaging,DWI)呈高信号。增强扫描均呈渐进性延迟强化,6例明显强化,9例轻至中度强化,6例肿块内见肿瘤血管。4例出现"胸膜尾征",12例肿瘤推压周围肺组织形成条带状高密度影。光学显微镜下见分化良好的梭形细胞散布于细长的胶原纤维之间,梭形细胞核分裂少见。免疫组织化学检测结果显示,Vimentin+(7/8)、CD34+(8/8)、Bcl-2+(5/8)。结论:SFTP可表现为边界清楚的孤立性肿块,体积较大,动态增强扫描呈延迟强化的影像学特征,可为临床提供诊断依据。Objective To investigate the radiologic and pathologic characteristics of solitary fibrous tumorof the pleura （SFTP）. Methods： A total of 15 cases of SFTP confirmed by surgery and pathology were retrospectivelyanalyzed. Thirteen cases underwent plain and enhanced CT scanning （one underwent MRI scanning at the same time）,and 2 cases underwent MRI scanning only. The location, size, shape, density or signal intensity and enhancementpattern of the tumors were studied. Results： All the 15 cases presented solitary masses with well-defined margin,among which 10 were round or oval-like and 5 were lobulated. Most of the masses showed iso-attenuation on plainCT with homogeneous or heterogeneous density, and 2 with calcification. Iso- or hypointense on T1WI, Iso- orhyperintense on T2WI, hyperintense on diffusion weighted imaging （DWI） were shown. After the administration ofcontrast agent, all of the tumors presented gradually delayed enhancement pattern. Six tumors manifested obviousenhancement, 9 tumors showed mild or moderate enhancement, and 6 tumors had affluent tumor vessel. Four casesshowed “pleura tail sign”, and 12 cases showed that surrounding lung tissues were pushed to form a strip with highdensity. Microscopically, these tumors consisted of whorls of reticulin and collagen with interspersed spindle-shapedcells, without significant nuclear division. Immunohistochemical analysis showed that Vimentin （＋） （7/8）, CD34 （＋）（8/8）, Bcl-2 （＋） （5/8）. Conclusion： SFTP can be expressed as an isolated mass with well-defined margin, lager size anddelayed enhancement pattern after enhancement, which can be used as clinical evidence for its diagnosis.

关 键 词：孤立性纤维瘤 胸膜 计算机断层扫描 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]