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·软组织疾病·

腺泡状软组织肉瘤的影像学特点分析

作者:梁建超1,2 洪国斌2 郭永飞3 古凌静1 杜中立1

所属单位:1.广东省珠海市人民医院 (广东 珠海 519000) 2.中山大学附属第五医院放射科 (广东 珠海 519000) 3.广州中医药大学中山附属医院放射科 (广东 中山 528400)

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摘要

目的 分析腺泡状软组织肉瘤(ASPS)的影像学表现,以提高对该病的认识。方法 回顾性分析5例经手术或穿刺病理 证实ASPS的影像学特点,重点观察病变边缘、深筋膜完整性、密度/信号、瘤内和瘤周肿瘤血管情况及强化特点 等。结果 4例表现为边缘不规则且深筋膜受侵,3例发生于下肢,1例发生于骨盆;1例发生于右肾者边缘亦欠规 则。1例行CT检查,平扫表现为低、稍高混杂密度。4例行MR检查, T1WI为稍高信号, T2WI高信号,瘤内及瘤周均 可见点条状流空信号影;增强扫描不均匀(1例)或均匀(3例)明显强化,瘤内及瘤周可见肿瘤血管影。5例均接受了 手术治疗,3例发生转移(1例确诊时即发生转移,2例术后发生肺或肝脏转移)。结论 ASPS影像学表现具有一定特 征,表现为CT平扫呈等/稍高密度,T1WI为稍高/高信号、瘤内及瘤周流空信号影、深筋膜破坏等,但确诊仍需组织 病理学。

Objective To investigate the imaging features of alveolar sort part sarcoma (ASPS), in order to further improve the understanding of the disease. Methods 5 cases with pathologically (surgery or biopsy) proved ASPS were analyzed retrospectively. Imaging features, including lesion edge, the deep fascia integrity, density/signal, tumor blood vessels in/around the masses and strengthening characteristic, were observed respectively. Results 4 cases were characterized by irregular edge and deep fascia invaded. 3 cases happened in the lower extremities, 1 case happened in pelvis.1 case happened in right kidney also had an irregular edge. CT was performed in 1 case, which showed low, mixed slightly higher density on plain scan. On MRI images of 4 cases, the masses showed hyper intensity on T1-weighted images and high intensity on T2-weighted images. And there were point-strip flow void signal in and around the masses. The masses showed heterogeneous(1 case) or homogeneous( 3 cases) enhancement after contrast. Tumor blood vessels could be seen in and around the masses. 5 cases were underwent surgery treatment, with metastases of 3 cases, 1 case metastasized at presentation, and lung or liver metastases were found after resections in other 2 cases. Conclusion ASPS has certain characteristics, which is slightly high density on CT plain scan, a bit higher/high signal on T1WI, flow void signal in and around the masses and the deep fascia integrity. But the final diagnosis still depends on histopathological examination.

【关键词】腺泡状软组织肉瘤;磁共振;CT

【中图分类号】R738.6

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2016.03.015

前言

腺泡状软组织肉瘤 ( A l v e o l a r s o f t p a r t sarcoma,ASPS)由Christopherson等于1952年首先命 名[1],在WHO 2013年第四版新分类中被归为不能确定 分化的恶性肿瘤[2],其发病极为罕见,占全部软组织 肉瘤的不足1%。ASPS通常表现为生长缓慢的无痛性肿 物,几乎不引起功能障碍,由于缺乏相关症状,肿瘤常被忽视,很多患者以肿瘤肺转移或脑转移为首发症 状[2]。笔者收集5例经手术或穿刺病理证实的ASPS, 报告如下。