腹部滤泡树突细胞肉瘤的影像学表现  

Imaging features of abdominal follicular dendritic cell sarcoma

作　　者：吴喆 张婉丽 赵越[3] 阎静[4] 陈婧 邓颖诗 丁文双[2] 杨蕊梦[1] WU Zhe;ZHANG Wan-li;ZHAO Yue(Department of Radiology,Guangzhou First People’s Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院放射科,广州510180 [2]广州市第一人民医院病理科,广州510180 [3]湛江中心人民医院放射影像科,广东524000 [4]郑州大学第一附属医院磁共振科,450052 [5]宜昌中心人民医院放射科,湖北443100

出　　处：《放射学实践》2022年第6期734-741,共8页Radiologic Practice

摘　　要：目的:探讨腹部滤泡树突细胞肉瘤(FDCS)影像学表现,提高对该病影像的认识。方法:回顾性分析2012年01月-2020年10月间经手术病理证实的13例FDCS患者的临床、病理及影像资料。所有患者均行CT平扫及增强检查,2例行MRI平扫及增强检查。重点观察及评价病变的部位、大小、形态、边界、数量、密度/信号、强化模式及有无转移。结果:13例FDCS中:①5例为典型FDCS,均来源于腹部肠系膜淋巴结(结内),其中3例为单发,2例多发(2个病灶);8例为炎性假瘤样滤泡树突细胞肉瘤(IPL-FDCS)(结外),其中6例病灶位于脾脏(均为单发),2例病灶位于肝脏(单发)。②所有病灶均边界清楚,呈膨胀性生长,12例为圆形或卵圆形,仅1例来源于腹部肠系膜淋巴结FDCS为分叶状。③10例FDCS内见囊变、坏死区,1例伴有钙化,2例脾脏来源FDCS合并出血;④肿瘤实质部分CT或MR增强扫描动脉期均呈明显强化,门静脉期持续强化,延迟期10例病灶(10/13)进一步强化,3例病灶(3/13)强化程度稍减退;⑤1例肠系膜淋巴结来源FDCS患者术后出现复发。结论:腹部FDCS多起源于淋巴结内或肝、脾,影像上多为单发、境界清楚的实性或囊实性肿块伴“渐进式强化”增强模式。在临床工作中遇到类似影像学表现的病例,应联想到该病的诊断。Objective:To summarize the imaging features of abdominal follicular dendritic cell sarcoma(FDCS).Methods:The clinical data,radiological manifestations and pathological findings of 13 patients with FDCS proven by pathology from January 2012 to October 2020 were retrospectively analyzed.All patients underwent unenhanced and dynamic contrast-enhanced CT scan,of which two performed MR scanning.Tumor location,number,size,morphology,CT attenuation/MR signal intensity,margin,absence/presence of metastasis,and enhancement characteristics were evaluated.Results:Among 13 patients,five were typical FDCSs originating from mesenteric lymph nodes,of which three were solitary and two were multiple;the remaining 8 were solitary inflammatory pseudotumor like FDCS(IPL-FDCS),of which six were located in the spleen and two were located in the liver.Al lesions showed well-defined margin with expansive pattern,of which 12 were round or oval and 1 originated from mesenteric lymph nodes with lobulated contour.Cystic changes and necrosis were seen in 10 and calcification in one,hemorrhages were in two from spleen.Most cases(10/13)demonstrated progressive enhancement patterns of the solid areas,the remaining three(3/13)were identified with rapid wash-in and slow wash-out enhancement patterns in their solid components.Tumor recurrence and lymph node metastases were found in one originating from mesenteric lymph nodes.Conclusion:Abdominal FDCS usually presents as a solitary,well-delineated solid or cystic-solid mass originating from lymph nodes or extra-nodal organs(most commonly in the liver and spleen)with“progressive enhancement”or“rapid wash-in and slow wash-out”enhancement pattern,accompanied with calcification or hemorrhage.

关 键 词：树突状细胞肉瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R733.1[医药卫生—肿瘤] R814.4[医药卫生—临床医学]