孤立性纤维性肿瘤15例CT影像病理特征分析

对比研究孤立性纤维性肿瘤(SFTs)的CT影像学特征及其与病理学的关系,评估CT在SFTs诊断中的应用价值。方法:收集15例孤立性纤维性肿瘤,回顾分析CT表现以及病理形态学和免疫表型变化。结果:15例中6例发生于胸腔内(3例发生于肺,3例位于壁层胸膜);此外鼻腔2例,上颌窦、腹腔、咽旁、腮腺、肾脏、眼眶、髂窝各1例。临床主要表现为局部肿块及其引起的压迫症状,CT扫描显示肿块边界清楚,增强扫描早期呈明显均质性强化。病理学改变显示瘤细胞呈梭形细胞为主,具有细胞密集区与细胞疏松区特征,间质可见瘢痕样的胶原和鹿角样厚壁血管,瘤细胞排列方式多样,免疫组化染色CD34阳性(91．67%), CD99(88．88%),Bcl-2(87．5%)和Vim(100%)。结论:SFT因有完整的包膜,故多为境界清楚的软组织密度肿瘤,如境界不清多提示侵袭性生长。因病理学上肿瘤细胞分布以及有无变性坏死而呈现不同的密度特征,因富血管表现而在增强CT扫描时有较为明显的强化;最终诊断需要免疫组织化学染色证实。

The Clinical Pathologic-CT Comparative Analysis on 15 Cases of Solitary Fibrous Tumor

Solitary fibrous tumor(SFT)is one of the rare entities of soft tissue tumors.The aim of this paper is to make comparative study on the clinical CT and pathological characteristics of solitary fibrous rumors (SFTs) and summarize our experience in the diagnosis of SFTs with CT.Methods:Fifteen cases of biopsy-or surgery-confirmed SFTs were studied using CT and the histopathological and immunohistochemical techniques.The clinic-pathologic and CT scan data of 15 cases were collected. The imaging features on CT were analyzed and the differential diagnoses were assessed.Immunohistochemical staining for CD34, vimentin,CD99,bcl-2,S-100,SMA,EMA was performed in all cases.Results:The 7 male and 8 female patients were from 31 to 73 years old,with an average age of 48 years at the time of diagnosis.Their SFTs were located in thoracic cavity (6/15,with 3/7 in lungs,3/7 in pleura),nasal cavity(2/15),maxillary sinus (1/15),abdominal cavity(1/15),parapharyngeal space(1/15),parofid salivary gland(1/15),kidney(1/15),fossa iliaca(1/15)and fossa orbitalis (1/15).The results showed 91.6% of positive staining for CD34,100% of positive Vim(vimentin)and 87.5% of positive Bcl-2 express.The main dirlical manifestations were local mass and pressure symptoms.The characteristic microscopic features included pattern-less growth pattern,altemating hyper-and hypo- cellular areas,blunt spindle cells with in keloidlike hyalinization,and hemangiopericytoma-like regions.The CT scan showed well- defined margins and smooth contours,homogeneous attenuation.Contrast enhanced CT showed early intense enhancement as a result of the rich vascularization.Homogeneous and geographic pattern contrast enhancement of the lesions in the early stage is the main feature.Conclusions:SFF is the soft tumors with well-defined margins and smooth contours.Due to the myxoid degeneration or hemorrhage,the homogeneous attenuation and homogeneous or geographic pattern contrast enhancement are the most typical features.