腹盆部良、恶性孤立性纤维瘤的CT鉴别诊断价值及病理学基础  

Differential Diagnosis of Benign and Malignant Solitar y Fibrous Tumor in Abdomen and Pelvisby CT and Its Pathological Basis

作　　者：钱国珍 孙永灿 纪东旭 张铭 李文杰 张恩龙 QIAN Guo-zhen;SUN Yong-can;JI Dong-xu;ZHANG Ming;LI Wen-jie;ZHANG En-long(Department of Radiology,Peking University International Hospital,Beijing 102206,China;Department of Pathology,Peking University International Hospital,Beijing 102206,China;Department of Retroperitoneal Tumor Surgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院放射科,北京102206 [2]北京大学国际医院病理科,北京102206 [3]北京大学国际医院腹膜后肿瘤外科,北京102206

出　　处：《中国CT和MRI杂志》2023年第6期153-155,共3页Chinese Journal of CT and MRI

基　　金：北京大学国际医院院内科研基金(YN2019QN03)

摘　　要：目的分析腹盆部良、恶性孤立性纤维瘤(SFT)的CT影像学表现及病理学特征,探讨CT对其诊断和鉴别诊断价值。方法回顾性分析34例腹盆部SFT患者的临床、病理及影像学资料,总结CT的影像学特点和术后病理结果。结果34例SFT中良性13例,恶性21例,平均年龄分别为45.3岁和56.2岁(P=0.01)。肿瘤最大径≥10cm(P=0.038)、动脉期见“蚯蚓钻土征”P=0.002)、静脉期见“地图样”强化(P=0.048)并呈平台型强化(P=0.001),这四种CT征象对于鉴别腹盆部良、恶性SFT具有诊断价值。免疫组化结果:Bcl-2+(28/34)例,CD34+(27/34)例,STAT6+(24/34)例、S-100-(34/34),Ki-67指数≥5%(23/34)例。6例良性SFT复发,7例恶性SFT复发。结论腹盆部良恶性SFT在CT上既有相似之处又存在差异性。恶性SFT患者年龄多较大、肿瘤体积较大、“蚯蚓钻土征”、“地图征”及静脉期呈平台型强化等特征更常见。同时结合病理学镜下特点和免疫组化结果可提高对SFT的良恶性鉴别。Objective To analyze the CT imaging features and pathological features of benign and malignant solitary fibroma(SFT)in abdominal and pelvic,and to explore the value of CT in its diagnosis and differential diagnosis.Methods The clinical,pathological and CT imaging datas of 34 patients with abdominal and pelvic SFT confirmed by pathology were retrospectively analyzed,to summarize the CT imaging features and postoperative pathological results.Results 13 cases were benign and 21 cases were malignant,with an average age of 45.3 years and 56.2 years respectively(P=0.01).The maximum diameter of tumor≥10cm(P=0.038),"earthworm drilling sign"(P=0.002)in arterial phase,"geopattern"enhancement(P=0.048)and platform enhancement(P=0.001)in venous phase,these four CT signs have diagnostic value for differentiating benign and malignant SFT in abdominal and pelvic region.Immunohistochemical results:Bcl-2+(28/34),CD34+(27/34),STAT6+(24/34),S-100-(34/34),Ki-67>5%(23/34).There were 6 cases of benign SFT recurrence and 7 cases of malignant SFT recurrence.Conclusion There are similarities and differences between benign and malignant abdominal and pelvic SFT on CT.Older age,larger tumor size,“earthworm burrowing”,“map sign”and platform enhancement in venous phase are more common in Malignant SFT patients.At the same time,combined with pathological microscopic features and immunohistochemical results,the differentiation diagnosis between benign and malignant SFT can be improved.

关 键 词：孤立性纤维瘤 腹盆部 CT 病理学 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]