腱鞘巨细胞瘤的影像学特征
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摘要
目的分析和总结腱鞘巨细胞瘤(GCTTS)的影像诊断和鉴别诊断特点,旨在提高对GCTTS的诊断水平。方法分析43例经病理证实的GCTTS患者的影像及病理资料。23例行X线检查; 9例行CT平扫检查; 25例行MRI平扫,8例同时行增强检查。结果 1) 43例患者无特征性临床表现;病灶在四肢大小关节发病率有显著统计学意义(P <0. 05); 2) X线平片7例骨质破坏,16例骨质及关节间隙正常,仅见关节周围软组织肿胀。CT平扫关节周围等密度肿块,密度均匀,边缘清楚; 1例见明显骨质破坏; 8例骨质结构未见明显破坏。在T1WI与骨骼肌信号对比11例呈等信号,10例呈稍低信号,4例呈等低信号;在T2WI与骨骼肌信号对比10例呈等信号,11例呈低信号,4例呈混杂信号;增强扫描肿块呈中度到明显的不均匀强化。结论 GCTTS主要发生在手足部,MRI对于GCTTS的诊断具有极高的敏感性和特异性。
Objective To analyze and summarize the imaging features of giant cell tumor of tendon sheath(GCTTS),so as to elevate the level of the diagnosis of GCTTS. Methods We analysed the imaging and pathological data from 43 patients with pathologically confirmed GCTTS. 23 patients were examined with X-ray; 9 patients were examined with CT; 25 patients were examined by MRI and 8 received contrast enhanced MRI. Results 1) 43 patients had no characteristic clinical manifestations; The morbidity in limb joints showed remarkable statistical significance(P < 0. 05); 2) Bony erosion of 7 cases was found in X-ray plain film; other showed no bony and joint abnormality,soft tissue swelling was found only around joints. CT scan showed equally-density lump around joints with clear border and homogeneous density; 1 case was obviously bony erosion; other showed no bony and joint abnormality. The lesions showed iso-intensity(n = 11),hypo-intensity(n = 10),and iso-and hypo-intensity(n = 4) on T1 WI compared with that of muscle; The lisions showed iso-intensity(n = 10),hypo-intensity(n = 11) and mixed hyper-and hypo-intensity(n = 4) on T2 WI compared with that of muscle. The lesions showed mainly moderately to marked inhomogeneous enhancement. Conclusion Most of GCTTS occured in distal limbs such as hands or feet. MRI has extremely high sensitivity and specificity for the diagnosis of GCTTS.
Objective To analyze and summarize the imaging features of giant cell tumor of tendon sheath(GCTTS),so as to elevate the level of the diagnosis of GCTTS. Methods We analysed the imaging and pathological data from 43 patients with pathologically confirmed GCTTS. 23 patients were examined with X-ray; 9 patients were examined with CT; 25 patients were examined by MRI and 8 received contrast enhanced MRI. Results 1) 43 patients had no characteristic clinical manifestations; The morbidity in limb joints showed remarkable statistical significance(P < 0. 05); 2) Bony erosion of 7 cases was found in X-ray plain film; other showed no bony and joint abnormality,soft tissue swelling was found only around joints. CT scan showed equally-density lump around joints with clear border and homogeneous density; 1 case was obviously bony erosion; other showed no bony and joint abnormality. The lesions showed iso-intensity(n = 11),hypo-intensity(n = 10),and iso-and hypo-intensity(n = 4) on T1 WI compared with that of muscle; The lisions showed iso-intensity(n = 10),hypo-intensity(n = 11) and mixed hyper-and hypo-intensity(n = 4) on T2 WI compared with that of muscle. The lesions showed mainly moderately to marked inhomogeneous enhancement. Conclusion Most of GCTTS occured in distal limbs such as hands or feet. MRI has extremely high sensitivity and specificity for the diagnosis of GCTTS.
引文
[1]高元桂,张爱莲,程流泉.肌肉骨骼磁共振成像诊断[M].北京:人民军医出版社,2013.459.
[2]Vogrincic GS,O’Connell JX,Gilks CB.Giant cell tumor of tendon sheath is a polyclonal cellular proliferation[J].Hum Pathol,1997,28(7):818-819.
[3]龚向阳.肌骨系统疾病CT 100例分析[M].杭州:浙江大学出版社,2001.194-195.
[4]王坚,朱雄增.2013版WHO软组织肿瘤新分类解读[J].中华病理学杂志,2013,42(6):363-365.
[5]Boland JM,Folpe AL,Homick JL,et al.Clusterin is expressed in normal synoviocytes and in tenosynovial giant cell tumors of localized and diffuse types:diagnostic and histogenetic implications[J].Am J Surg Pathol,2009,33(8):1225-1229.
[6]汤莉,周隽,蒋智铭,等.腱鞘巨细胞瘤clusterin表达对病理诊断和组织发生的意义[J].中华病理学杂志,2012,41(3):161-167.
[7]孙屏,张熔熔.足底伴有软骨分化的腱鞘巨细胞瘤一例[J].中华病理学杂志,2015,44(9):677-678.
[8]苏振清,黄鑫龙,胡仁建,等.腱鞘巨细胞瘤的MRI诊断[J].实用放射学杂志,2012,28(1):88-91.
[9]Gholve PA,Hosalkar HS,Kreiger PA,et al.Giant cell tumor of tendon sheath:largest single series in children[J].J Pediatr Orthop,2007,27(1):67-74.
[10]黄利华,赵晓玲,刘冬玲,等.腱鞘巨细胞瘤60例临床病理分析[J].临床与实验病理学杂志,2011,27(12):1362-1363.
[11]杨毅,蒋震,赵文露,等.DR对手足部腱鞘巨细胞瘤的诊断价值[J].临床放射学杂志,2013,32(3):393-395.
[12]De Schepper AM,Hogendoorn PC,Bloem JL.Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions[J].Eur Radiol,2007,17(2):499-502.
[13]潘勇卫,田光磊,荣国威,等.手部腱鞘巨细胞瘤的临床病理研究与免疫组化及流式细胞分析[J].中华骨科杂志,2005,25(6):342-348.
[14]顾东华,孙明.腱鞘巨细胞瘤的影像学诊断(附13例分析)[J].放射学实践,2011,26(5):530-533.
[15]陈基明,吴莉莉,翟建,等.大关节腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎的MRI特征及其鉴别诊断[J].临床放射学杂志,2015,34(10):1638-1642.
[16]谭源满,吴艳,叶思婷,等.色素沉着绒毛结节性滑膜炎与腱鞘巨细胞瘤的MRI诊断[J].医学影像学杂志,2017,27(1):125-127.
[17]李锋,王仁法,祁良,等.软组织滑膜肉瘤的CT和MRI诊断[J].放射学实践,2010,25(12):1396-1399.
[18]郭启勇.实用放射学[M].第3版.北京:人民卫生出版社,2013.1177-1178.
[19]Zhang Y,Huang J,Ma X,et al.Giant cell tumor of the tendon sheath in the foot and ankle:case series and review of the literature[J].J Foot Ankle Surg,2013,52(1):24-27.
[20]张学勇,王明杰,李旭丹.腱鞘巨细胞瘤的影像学分析[J].医学影像学杂志,2013,23(8):1300-1303.
[2]Vogrincic GS,O’Connell JX,Gilks CB.Giant cell tumor of tendon sheath is a polyclonal cellular proliferation[J].Hum Pathol,1997,28(7):818-819.
[3]龚向阳.肌骨系统疾病CT 100例分析[M].杭州:浙江大学出版社,2001.194-195.
[4]王坚,朱雄增.2013版WHO软组织肿瘤新分类解读[J].中华病理学杂志,2013,42(6):363-365.
[5]Boland JM,Folpe AL,Homick JL,et al.Clusterin is expressed in normal synoviocytes and in tenosynovial giant cell tumors of localized and diffuse types:diagnostic and histogenetic implications[J].Am J Surg Pathol,2009,33(8):1225-1229.
[6]汤莉,周隽,蒋智铭,等.腱鞘巨细胞瘤clusterin表达对病理诊断和组织发生的意义[J].中华病理学杂志,2012,41(3):161-167.
[7]孙屏,张熔熔.足底伴有软骨分化的腱鞘巨细胞瘤一例[J].中华病理学杂志,2015,44(9):677-678.
[8]苏振清,黄鑫龙,胡仁建,等.腱鞘巨细胞瘤的MRI诊断[J].实用放射学杂志,2012,28(1):88-91.
[9]Gholve PA,Hosalkar HS,Kreiger PA,et al.Giant cell tumor of tendon sheath:largest single series in children[J].J Pediatr Orthop,2007,27(1):67-74.
[10]黄利华,赵晓玲,刘冬玲,等.腱鞘巨细胞瘤60例临床病理分析[J].临床与实验病理学杂志,2011,27(12):1362-1363.
[11]杨毅,蒋震,赵文露,等.DR对手足部腱鞘巨细胞瘤的诊断价值[J].临床放射学杂志,2013,32(3):393-395.
[12]De Schepper AM,Hogendoorn PC,Bloem JL.Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions[J].Eur Radiol,2007,17(2):499-502.
[13]潘勇卫,田光磊,荣国威,等.手部腱鞘巨细胞瘤的临床病理研究与免疫组化及流式细胞分析[J].中华骨科杂志,2005,25(6):342-348.
[14]顾东华,孙明.腱鞘巨细胞瘤的影像学诊断(附13例分析)[J].放射学实践,2011,26(5):530-533.
[15]陈基明,吴莉莉,翟建,等.大关节腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎的MRI特征及其鉴别诊断[J].临床放射学杂志,2015,34(10):1638-1642.
[16]谭源满,吴艳,叶思婷,等.色素沉着绒毛结节性滑膜炎与腱鞘巨细胞瘤的MRI诊断[J].医学影像学杂志,2017,27(1):125-127.
[17]李锋,王仁法,祁良,等.软组织滑膜肉瘤的CT和MRI诊断[J].放射学实践,2010,25(12):1396-1399.
[18]郭启勇.实用放射学[M].第3版.北京:人民卫生出版社,2013.1177-1178.
[19]Zhang Y,Huang J,Ma X,et al.Giant cell tumor of the tendon sheath in the foot and ankle:case series and review of the literature[J].J Foot Ankle Surg,2013,52(1):24-27.
[20]张学勇,王明杰,李旭丹.腱鞘巨细胞瘤的影像学分析[J].医学影像学杂志,2013,23(8):1300-1303.