原发性肺滑膜肉瘤CT特征及临床病理分析  

CT features and clinicopathological analysis of primary pulmonary synovial sarcoma

作　　者：滕陈迪 周海生 杨运俊[3] TENG Chendi;ZHOU Haisheng;YANG Yunjun(Department of Radiology,Wenzhou Central Hospital,Wenzhou,Zhejiang 325000,China;Department of Radiology,Yueqing People’s Hospital,Yueqing,Zhejiang 325600,China;Department of Radiology,the First Affiliated Hospital of Wenzhou Medical College,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江省温州市中心医院放射科,325000 [2]浙江省乐清市人民医院放射科,325600 [3]温州医科大学附属一医放射科,浙江温州325000

出　　处：《重庆医学》2023年第7期1040-1046,共7页Chongqing medicine

摘　　要：目的 探讨原发性肺滑膜肉瘤(PPSS)的CT特征。方法 回顾性分析经手术病理确诊的10例PPSS患者CT表现,观察肿瘤位置、大小、形状、密度、边缘及强化程度等情况。组织标本切片经苏木素-伊红(HE)染色,光镜下观察病理;免疫组织化学EnVision法检测抗体波形蛋白(Vim)、细胞角蛋白(CK)、EMA、CD99、CK7、CK19、平滑肌肌动蛋白(SMA)、S-100和结蛋白(Desmin)表达。结果 10例患者中周围型7例,病灶呈团块状,中央型3例,病灶呈团片状;肿瘤直径3.2~12.0 cm,平均(7.1±3.2)cm;CT平扫肿瘤呈不均匀低密度7例,均匀等密度3例;肿瘤边缘不光整与界限不清楚7例,边缘光整与界限清楚3例;增强扫描后9例动脉期呈轻中度强化,门静脉期持续轻度强化,延迟期强化缓慢退出;1例动脉期显著不均匀强化,门脉期持续轻度强化,延迟期强化缓慢退出。双相型4例:肿瘤细胞差分化,恶性度高,瘤内有局灶性坏死;CT平扫示大多数肿瘤直径>8.0 cm,呈不均匀略低密度,边缘不光整,瘤内坏死囊变;增强扫描多呈显著或中度不均匀强化。单相纤维型或单相上皮型6例:瘤细胞由卵圆形、梭形细胞构成,瘤内有少量致密纤维化区,伴黏液样区;CT平扫示大多数肿瘤直径<6.5 cm,呈均匀或不均匀或略低密度,边缘较光整;增强扫描多呈持续轻度不均匀强化为主。结论 PPSS罕见,其形状多呈团块状和团片状,肿瘤界限较清楚,密度均匀或不均匀,CT增强扫描以轻中度不均匀持续强化为特征。Objective To investigate the CT features of primary pulmonary synovial sarcoma(PPSS).Methods The CT manifestations of 10 patients with PPSS confirmed by surgery and pathology were retrospectively analyzed,and the location,size,shape,density,edge and enhancement of the tumor were observed.The tissue sections were stained with hematoxylin-eosin(HE),and observed under light microscope;The expression of vimentin(Vim)and cytokeratin(CK),EMA,CD99,CK7,CK19,smooth actin(SMA),S-100 and Desmin were detected by immunohistochemistry EnVision method.Results Of the 10 patients,7 patients were peripheral type,the lesions were lumpy,3 patients were central type,and the lesions were flaky.The maximum diameter of the tumor was 3.2-12.0 cm,with an average of(7.1±3.2)cm.Plain CT scan showed uneven low density in 7 cases and uniform isodensity in 3 cases;there were 7 cases with irregular edge and unclear boundary,and 3 cases with smooth edge and clear boundary;After enhancement,9 cases showed mild and moderate enhancement in the arterial phase,continuous mild enhancement in the portal venous phase,and the enhancement slowly withdrawal in the delayed phase;There were 4 cases of bipolar type:tumor cells are poorly differentiated,with high malignancy and focal necrosis in the tumor;plain CT scan showed that most of them the largest diameter of the the tumors was>8.0 cm,which showed uneven slightly low density,irregular edge,and necrosis and cystic degeneration in the tumor,significant or moderate uneven enhancement was observed in most focus after enhancement scans.There were 6 cases of monophasic fibrous or unilateral epithelial type:the tumor cells were composed of oval and spindle cells,and there were a small amount of dense fibrotic areas in the tumor with mucoid areas;CT plain scan showed that most of them the maximum diameter of the tumor was<6.5 cm,and the tumor was homogeneous or uneven with equal or slightly lower density,and the edge was smooth;Most of the enhancement scans showed continuous slight uneven enhancement.Conclusi

关 键 词：滑膜肿瘤 肺肉瘤 体层摄影术 X线计算机 病理 

分 类 号：R734.2[医药卫生—肿瘤]