颅内孤立性纤维瘤/血管外皮细胞瘤影像表现与病理相关分析  

Intracranial solitary fibrous tumor/hemangiopericytoma:imaging findings and pathologic features

作　　者：林家权 蒋牧良[1] 毛一朴[2] 龙莉玲[1] LIN Jiaquan;JIANG Muliang;MAO Yipu;LONG Liling(Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Radiology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院放射科,广西南宁530021 [2]广西壮族自治区人民医院CT室,广西南宁530021

出　　处：《实用放射学杂志》2019年第12期1901-1905,1929,共6页Journal of Practical Radiology

摘　　要：目的探讨颅内孤立性纤维瘤(SFT)/血管外皮细胞瘤(HPC)的影像表现与相关病理特征,提高诊断率。方法回顾性分析21例经手术病理证实的颅内SFT/HPC的影像及病理学资料。结果根据2016版WHO中枢神经系统肿瘤分级,SFT/HPCⅠ级8例,Ⅱ级7例,Ⅲ级6例;男6例,女15例;年龄27-77岁,平均(44.3±13.7)岁。本组21例均为单发,脑外20例,脑实质内1例,其中小脑幕4例,大脑镰2例,脑凸面7例,桥小脑角区1例,鞍区1例,颅窝5例,额叶1例;最大长径1.7-8.0 cm,平均(5.45±1.95)cm。CT表现肿瘤呈类圆形(4例)、分叶状(4例),以稍高密度为主(7例),1例Ⅲ级呈低密度;2例见钙化,7例见囊变、坏死,7例见轻度瘤周水肿。增强扫描肿瘤均匀(1例)或不均匀(2例)明显强化。MRI肿瘤呈圆形或类圆形(4例)、分叶状(14例),肿瘤实性部分T1WI以等或稍低信号为主(15例),SFT/HPCⅡ级、Ⅲ级T2WI以等或稍高信号为主(11例);11例肿瘤内见囊变、坏死,11例见血管流空,14例见皮质塌陷征,13例见瘤周脑脊液,15例见瘤周水肿,7例中线移位或脑室受压;9例增强扫描明显不均匀强化;7例明显均匀强化;4例见脑膜尾征;4例见静脉窦受累;5例邻近骨质破坏。免疫组化结果显示21例vimentin和CD34几乎均为阳性;GFAP、S-100均未见表达。网状纤维染色是SFT/HPCⅡ级和Ⅲ级较有特异性的表现。结论颅内SFT/HPC的影像表现与其生物学级别有一定的相关性,Ki-67指数与病理特征及影像学特征相结合作为预测预后的可能指标。Objective To identify the imaging characteristics of intracranial solitary fibrous tumor/hemangiopericytoma(SFT/HPC)with pathological correlation and improve the diagnostic rate.Methods The imaging and patholigical data of 21 cases with intracranial SFT/HPC which confirmed by pathologically were analyzed retrospectively.Results According to the 2016 WHO classification of central nervous system tumors,8 benign(grade Ⅰ),7 borderline(grade Ⅱ)and 6 malignant(grade Ⅲ)intracranial SFT/HPC were identified.This study included 21 patients[6 men and 15 women,average age(44.3±13.7)years,rage 27-77 years].All of the 21 cases[average diameter(5.45±1.95)cm,rage 1.7-8.0 cm]were showed as solitary lesion and 20 cases were extra-axial,and 1 case intra-axial.Those lesions were occurred in tentorium(n=4),falx(n=2),brain convex(n=7),cerebellopontine hom area(n=1),sella area(n=1),cranialfossa(n=5),frontal lobe(n=1).Non-contrast CT imaging findings showed round/oval(n=4)or lobulated(n=4),and showed slightly hyper-density(n=7),homogeneous hypo-density(n=1,grade Ⅲ),punctuate calcification(n=2),cystic necrosis(n=7),slight edema(n=7).After intravenous contrast median injection,the lesions showed homogeneous(n=1)and heterogeneous(n=2)enhancement.Unenhanced MRI findings showed round/oval(n=4),lobulated(n=14),the parenchyma of the lesions mainly showed iso-/slight hypo-intenseon T1WI(n=15)and iso-/slight hyper-intense on T2 WI(grade Ⅱ,Ⅲ,n=11);cystic degeneration(n=11),vascular flow voids(n=11),cortical collapse sign(n=14),peritumoral ring with cerebrospinal fluid signal(n=13),peritumoral edema(n=15),midline shift or lateral ventricle compression(n=7),bone destruction(n=5)were observed in the lesions;heterogeneous(n=9)and homogeneous(n=7)enhancement,meningeal sign(n=4),involved venous sinus(n=4)were observed on the contrast-enhanced MRI images.All 21 cases exhibited positives staining for vimentin,CD34.GFAP and S-100 negative staining.Reticula fiber staining was a special manifestation of intracranial SFT/HPC(grade Ⅱ-Ⅲ).Conc

关 键 词：孤立性纤维瘤 血管外皮细胞瘤 计算机体层成像 磁共振成像 病理学 

分 类 号：R739.41[医药卫生—肿瘤] R814.42[医药卫生—临床医学]