原发性骶尾部脊索瘤的临床表现、病理特征与MRI征象  

Clinical manifestations,pathological features and MRI characteristics of primary sacrococcygeal chordoma

作　　者：陈芳妮 钟南哲 王玮 刘士远 王晨光 赵洪波 CHEN Fangnil;ZHONG Nanzhe;WANG Wei;LIU Shigyuan;WANG Chenguang;ZHAO Hongbo(Department of Radiology and Nuclear Medicine,Changzheng Hospital,Naval Medical University,Shanghai 200003,China;Department of Orthopedic Oncology,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学长征医院影像医学与核医学科,上海200003 [2]海军军医大学长征医院骨肿瘤科,上海200003

出　　处：《实用放射学杂志》2021年第3期438-442,共5页Journal of Practical Radiology

基　　金：青年科学基金项目(81902731)。

摘　　要：目的探讨原发性骶尾部脊索瘤(PSC)的临床表现、病理特征及MRI征象。方法回顾性分析80例PSC患者的临床、病理和MRI影像资料,并进行统计学分析,探讨三者之间有无关联。结果临床病程6 d~30年,患者骶尾部疼痛70例,肠道、膀胱、下肢功能障碍分别为56例、35例、35例。病理分型:经典型79例,去分化型1例。细胞角蛋白、波形蛋白、上皮膜抗原及S-100表达阳性的病例数分别为78例、75例、78例及65例,Ki-67指数为0%~30%。MRI表现:69例位置居中,68例骶髂关节未受累,46例累及S2或以上;T1WI以低信号为主,T2WI以高信号为主,增强后63例呈囊实性,17例呈囊性;肿瘤的左右径及上下径明显大于前后径(P<0.05)。膀胱功能障碍与S2神经受累有关(P<0.05)。结论PSC临床病程长短不一,常见症状为骶尾部疼痛、肠道功能障碍。大部分病例病理证实为经典型脊索瘤。MRI图像多数肿瘤位置居中,呈囊实性,前后生长受限;1/2以上累及S2或以上;较少累及骶髂关节。膀胱功能障碍与S2神经受累有关。Objective To investigate the clinical manifestations,pathological features and MRI characteristics of.primary sacrococcygeal chordoma(PSC).Methods Clinical records,pathological reports and MRI data of 80 patients with PSC were retrospectively reviewed and relationships among them were analyzed statistically.Results The course of disease was from 6 days to 30 years.The cases of sacrococcygeal pain,bowel dysfunction,bladder dysfunction and lower extremity dysfunction were 70,56,35 and 35,respectively.The conventional and dedifferentiated chordoma of pathological subtypes were 79 and 1,respectively.The positive expressions cases of CK,Vimentin,EMA and S-100 were 78,75,78 and 65,respectively;Ki-67 indexes were 0%-30%.MRI showed that 69 cases located in the midline;S2 or above were involved by the tumor in 46 cases;the sacroiliac joints of 68 cases were intact,The cystic and solid-cystic tumors presented in 17 and 63 cases respectively.The maximal superoinferior and transverse diameters were larger than the maximal anteroposterior diameter significantly(P<0.05).The bladder dysfunction was related to S2 nerve involvement(P<0.05).Conclusion The course of disease in patients with PSC is variable.The sacrococcygeal pain and bowel dysfunction are common symp-toms in PSC.Most of the cases are conventional chordoma by pathology confirmed.MRI shows that most of the cases are solid-cystic and located in the midline;the tumor growth is limited in anterior posterior direction;more than half of cases involve S2 or above;the sacroiliac joint is seldom encroached.The bladder dysfunction is related to S2 nerve involvement.

关 键 词：骶尾部 脊索瘤 病理学 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤] R446.8[医药卫生—临床医学]