大关节弥漫型腱鞘巨细胞瘤的影像学诊断

目的 探讨大关节弥漫型腱鞘巨细胞瘤（diffuse giant cell tumor of tendon sheath,D-GCTTS）的影像学表现特点。 方法　回顾性分析11例经手术病理证实的D-GCTTS患者的影像学资料。所有患者均行X线及MRI检查,7例行CT检查。 结果　X线检查均表现为关节旁见密度略高于肌肉的软组织肿块影,其中7例关节面下方见骨质破坏,边界较清楚;7例行CT平扫显示软组织肿块和骨质破坏征象较X线平片清晰,呈跨关节性骨质破坏,边缘硬化,软组织肿块内未见钙化。MRI检查显示病灶范围较CT清楚,9例均表现为骨旁、关节旁软组织肿块影,呈分叶状、团状,边界清楚,信号不均匀,各序列以低信号为主;6例增强后病灶呈中等度或明显不均匀强化;骨质破坏7 例,骨质破坏区信号与软组织肿块一致;关节积液 2 例。结论　大关节弥漫型腱鞘巨细胞瘤的影像表现具有一定特征性,结合X线平片、CT表现的骨质破坏情况及MRI病灶出现特征性的双低信号,可作出明确诊断。     

25例手足腱鞘巨细胞瘤MRI分析

[目的]分析手足腱鞘巨细胞瘤（giant cell tumors of the tendon sheath,GCTTS）的MRI表现,以提高对其认识和诊断水平。[方法]回顾性分析25例经手术病理证实的手足部GCTTS患者的MRI表现特点。[结果]25例手足部GCTTS中,局限型20例,弥漫型5例,所有病例均可见软组织肿块紧贴或包绕肌腱生长,其中5例可见邻近骨质侵蚀。病灶信号与正常骨胳肌相比,T1WI上19例呈等信号,4例呈等低信号,2例呈低信号;T2WI上信号表现多样化,9例呈混杂信号,6例呈高信号,4例呈稍高信号,6例呈低信号;12例增强扫描后,9例病灶呈明显不均匀强化,3例呈明显均匀强化。[结论]手足GCTTS以局限型多见,MRI上表现有特征性,MRI检查对疾病诊断、治疗方案制定等可提供可靠依据。     

骨盆骨巨细胞瘤X线、CT及MRI表现

目的 结合病理总结骨盆骨巨细胞瘤影像学特点及鉴别诊断要点.方法 32例骨盆骨巨细胞瘤患者均经手术与病理证实,其中骶骨18例,髂骨6例,耻骨4例,坐骨4例.所有病例均行X线、CT和MRI检查,将影像学表现与手术病理结果进行对照,并由双盲法分析确认.结果 骨盆骨巨细胞瘤影像学表现包括膨胀性骨质破坏、溶骨性骨质破坏和软组织肿块.32例中,膨胀性病变26例,溶骨性骨质破坏6例,软组织肿块18例.CT显示骨质破坏优于x线平片,MRI可清晰显示肿瘤周围的软组织肿块和神经血管侵犯情况.结论 综合临床表现与X线平片、CT、MRI检查资料可提高骨巨细胞瘤诊断及鉴别诊断的准确性.     

骨巨细胞瘤影像学诊断价值的比较

目的通过骨巨细胞瘤常见和典型的X线、CT及MRI表现的比较,提高对该病诊断和鉴别诊断的能力。方法回顾性分析19例经手术病理证实为骨巨细胞瘤患者的X线、CT及MRI表现。结果 X线平片表现:溶骨性骨质破坏14例,均呈膨胀性生长,边界尚清晰;硬化性骨质破坏1例,病理性骨折。CT表现:13例呈偏心膨胀性骨质破坏,均见局限性硬化边,12例见棘状、尖角状、条索状骨嵴及硬化边征象,10例软组织肿块影。MRI表现:7例MRI T1WI上均主体呈等信号夹杂少量低信号,T2WI及T2压脂相呈低信号等信号、高混杂信号,DWI呈高信号。结论骨巨细胞瘤的影像学表现为偏心性、膨胀性溶骨破坏,X线平片、CT及MRI影像检查相互补充,能够增加骨巨细胞瘤诊断及鉴别诊断的准确性。     

颅内少突-星形细胞瘤的CT、MRI表现

目的探讨颅内少突-星形细胞瘤的CT、MRI特征和诊断价值。方法对17例经手术病理证实的颅内少突-星形细胞瘤患者进行临床和影像学分析。结果（1）17例均行CT、MRI平扫及增强检查,病灶均位于大脑半球且累及灰白质。额叶3例,顶叶2例,颞叶1例,额顶叶5例,颞顶叶4例,枕顶叶2例。（2）MRI表现：肿瘤T1WI加权呈等或低信号,T2WI加权呈稍高或高信号,DWI和SE-EPI成像,病灶及周围水肿呈高信号。（3）CT平扫病灶呈等或低密度,9例病灶内钙化,8例多发囊性低密度区。（4）增强扫描：病灶呈明显不均匀强化。实性部分轻至中度强化,囊变区无强化。结论颅内少突-星形细胞瘤临床及影像学表现无特异性。CT及MRI检查可明确病灶部位及范围,定性诊断须结合临床及病理学检查。     

腱鞘巨细胞瘤

腱鞘巨细胞瘤又名局限性结节性腱鞘炎、巨细胞性腱鞘炎、滑膜纤维黄色瘤，首先由Ｃｈａｓｓａｉｇｎａｃ以“腱鞘癌”报告（１８５２年），直至１９１５年Ｂｅｅｋｍａｎ才定为“腱鞘巨细胞瘤”。国内李静１９５９年首先报告一例，以后有零星报道，我院从１９８９年～１９...     

增强CT定量分析在骨巨细胞瘤定性诊断中的价值

目的探讨MSCT增强扫描CT定量分析在骨巨细胞瘤的定性诊断中的应用价值。方法分别单独应用MSCT增强后强化CT值及强化CT值＋年龄、部位和形态学特征等综合因素对我院329例溶骨性骨肿瘤或肿瘤样病变进行骨巨细胞瘤的前瞻性预判,分别划分骨巨细胞瘤组（实验组）与非骨巨细胞瘤组（对照组）进行统计学分析,定量研究CT增强扫描后CT值的变化特征,并追踪病理结果对照,最终有病理结果的186例中骨巨细胞瘤55例。结果在186例肿瘤或肿瘤样病变中,骨巨细胞瘤55例,增强后强化最显著区域平均CT值为（108±39）HU;非骨巨细胞瘤131例,增强后强化最显著区域平均CT值为（82±78）HU;二者差异有统计学意义（P＜0.05）。当选取CT值临界点为97HU为标准进行预判时,诊断骨巨细胞瘤的敏感性为87.27%,特异性为78.62%,诊断正确率为81.18%;同时结合患者年龄及发病部位、形态特征等综合因素进行预判时,诊断骨巨细胞瘤诊断的敏感性为96.36%,特异性为96.18%,诊断准确率为96.23%。结论 CT增强扫描中CT值的定量分析在骨巨细胞瘤的定性诊断中有较好的导向价值,如果结合患者年龄及发病部位、形态学特征等综合因素进行预判,可以提高术前诊断正确率。     

骨良性纤维组织细胞瘤的影像诊断与病理对照

摘 要：［目的］ 探讨骨原发性良性纤维组织细胞瘤(BFH)的影像学表现及其病理特点。［方法］ 回顾性分析15例经手术病理证实的骨良性纤维组织细胞瘤的影像资料,并将之与手术病理结果对比。［结果］ 临床以局部疼痛为主。发病部位以四肢长骨居多,单发病变14例,多发病变1例。10例病例行X线检查,11例行CT检查,6例行MRI检查。X线表现大部分为中央型溶骨性破坏,单房或多房状,部分病灶膨胀,皮质断裂。CT显示病灶边界清楚,周围可伴有或不伴有硬化边缘,硬化缘厚薄不均。MRI显示所有病例在T1WI上类似肌肉信号,4例T2WI及T2WI压脂像上见斑片状或条索状低信号区,2例病灶整体呈稍高信号。3例病灶穿破骨皮质向外侵犯,周缘软组织见反应性水肿。术中见瘤体为灰黄色或褐黄色组织,镜下由漩涡样排列的梭形纤维母细胞构成,其间散在多核巨细胞和泡沫细胞,无成骨组织。［结论］ 骨良性纤维组织细胞瘤的影像表现有一定的特点,也反映了其病理改变,综合各种影像表现并结合临床特点,多数典型病例可作出诊断。     

下肢腱鞘巨细胞瘤12例临床分析

通过对12例下肢腱鞘巨细胞瘤的临床诊治实践的探讨，认为正确的诊断和治疗方法（即彻底的肿瘤组织切除）是防止本病复发的唯一方法。     

Malignant Giant Cell Tumor of the Tendon Sheath: An Autopsy Report and Review of the Literature

A case of malignant giant cell tumor of the tendon sheath ofthe right hip, which developed in a 72-year-old Japanese woman,is described. The tumor exhibited histological similaritiesto a benign giant cell tumor of the tendon sheath (localizednodular tenosynovitis). The resected tumor, measuring 9x9x11cm, was located in the adductor muscle and invaded the proximalfemur and acetabulum. The nodule was encapsulated with a thinmembrane which was soft and gelatinous in consistency and variedin color from yellow to brown. The synovium of the hip jointwas normal. The primary lesion was composed of plump polyhedraland spindle-shaped cells. The nuclei were large, irregular andhyperchromatic, and contained prominent nucleoli. A moderatednumber of multinucleated giant cells was scattered throughoutthe lesion. There was little stromal collagen. In the majorityof the specimens, pseudoglandular or alveolar spaces were predominant.An ultrastructural study demonstrated three cell types: fibroblast-like,histiocyte-like and an intermediate. The patient underwent reconstructivesurgery with a Dacron fabric-enveloped alumina ceramic pelvicprosthesis and total hip components after resection of the primarylesion. Unfortunately, because of a local recurrence, a hemipelvectomywas required 10 months after the initial operation. At thattime the intestines were involved with the recurrent tumor,and the patient subsequently died of perforative peritonitis.An autopsy revealed distant metastases to the right pelvis,urinary bladder, right ureter, ilium, mesenterium and lungs.     

肺炎性假瘤31例的X线表现分析

本文报道我院自1974年4月至1982年4月,8年间共收治肺炎性假瘤31例,其中男18例,女13例,均经手术和病理证实。X线检查发现右肺22例(以肺下叶为主,计13例),左肺9例(下叶5例)。肿块阴影多位于肺边缘区,呈圆形或椭圆形,且边界清晰(16例),或毛刺状(11例,其中7侧尚呈分叶状),另4例为浸润性。密度居中而均匀(12侧),少数较密(4例)或稍淡(7例),易误诊为良性瘤或癌。个别者见厚壁空洞(2例),肿块内见斑点状钙化(2例)或浸润状(4例),易误诊为癌,结核球或错构瘤。呈浸润状者,术中皆证实与周围组织粘连,本纽共17例,均有平片断层,26例肺门正常,5例肺可见肿大淋巴结,但病理检查皆为炎性。     

卵巢恶性生殖细胞肿瘤31例临床分析

[目的]探讨改善卵巢恶性生殖细胞肿瘤疗效、提高生存质量的方法。[方法]回顾1994年～1997年治疗的恶性生殖细胞肿瘤31例,分析其疗效以及影响预后的因素。[结果]Ⅰ期20例、Ⅱ期2例、Ⅲ期8例、Ⅳ期1例。病理类型:未成熟畸胎瘤9例、无性细胞瘤9例、混合性生殖细胞瘤7例、内胚窦瘤5例、胚胎癌1例。患侧附件切除13例,全子宫+双附件+大网膜+阑尾切除16例,2例因无法减瘤仅行探查活检。31例术后均接受以铂类药物为基础的腹腔化疗2～3次,继以全身化疗3～6个疗程。全组23例无瘤生存5年以上。早期病例生存率较晚期高(P=0.004)。无性细胞瘤、混合性生殖细胞瘤及未成熟畸胎瘤预后较内胚窦瘤和胚胎癌好(P<0.05)。Ⅰ期13例单纯附件切除组5年生存12例,7例行根治术组5年生存6例,差异无显著性(P>0.05)。[结论]临床分期是最重要的预后因素,早期病例完全可行患侧附件切除术。     

51例复发性骨巨细胞瘤的治疗

目的：探讨复发性骨巨细胞瘤（GCT）的治疗。方法：回顾51例四肢复发性GCT的临床资料．分析治疗效果。外科治疗依据病理和影像学分期，进行扩大的肿瘤刮除、辅助囊壁处理或肿瘤切除功能重建。结果：平均随访36个月，再复发8例，总复发率为15．7％，局部囊内刮除后再复发率为22．7％（5／22），肿瘤边缘切除后再复发率11．5％（3／26），手术并发症发生率为9．8％、结论：GCT复发后肿瘤局限且无明显软组织肿块，再次刮除空腔充填；有明显软组织肿块形成的Campanacci Ⅲ级和部分肿瘤较大的Ⅱ级患者，行瘤段切除后功能重建，选择性治疗可获得满意的疗效。     

骨巨细胞瘤67例临床病理学研究

本文报告６７例ＧＣＴ的临床病理学改变，男性４６例，女性２１例。发病年龄在４０岁以前者占８０．１％。以下肢长管状骨最为常见，为７２％。按Ⅲ级分类法，Ⅰ、Ⅱ、Ⅲ级病例数分别为３１、２３、１３例。治疗后全部病例复发率为５９％。本文详细研究了具有恶性特征的ＧＣＴ的Ｘ线特征，认为临床、Ｘ线和病理相结合，对骨巨细胞瘤的诊断和治疗有重要意义。     

Giant Cell Tumor of Bone

The role of enhanced fluorodeoxyglucose F 18 uptake of giant cell tumor of bone (GCTB) should be mentioned in an overview such as that reported by van der Heijden et al., with regard not only to the response to denosumab treatment for unresectable GCTB but also to the clinical implications for the diagnosis of this disease.In a recent article in The Oncologist, van der Heijden et al. [1] provided an overview of imaging, histopathology, genetics, and multidisciplinary treatment of giant cell tumor of bone (GCTB). The authors, however, do not mention the role of metabolic imaging with fluorodeoxyglucose F 18 (¹⁸F-FDG) positron emission tomography/computed tomography scans (PET/CT) in the diagnosis of this disease; they cite only the reduced uptake on ¹⁸F-FDG PET/CT after denosumab treatment [2]. In addition to conventional radiographs and contrast-enhanced magnetic resonance imaging (MRI), ¹⁸F-FDG PET/CT may be helpful for gaining diagnostic information by assessing tumor metabolism [3–6]. Recently we observed a 55-year-old man with melanoma for which FDG-PET/CT performed as a staging procedure revealed enhanced ¹⁸F-FDG uptake (a maximum SUV of 9.96) at the level of the proximal end of the right fibule (Fig. 1). This uptake was interpreted as bone metastasis from the melanoma. Conventional radiograph CT scans of the right leg revealed an osteolytic lesion; MRI confirmed the lesion with a low signal on T1- and T2-weighted spin-echo invading and reinflating the cortical bone and surrounded by a sclerotic area. To allow a definite diagnosis, an open biopsy of the lesion was performed, and histopathology examination showed a giant cell tumor of the bone and not metastatic melanoma, as suspected. As reported by van der Heijden et al. [1], GCTB is an intermediate, locally aggressive, but rarely metastasizing tumor. Despite their histopathology classification, giant cell tumors have generally enhanced ¹⁸F-FDG uptake, attributable mainly to an enhanced vascular fraction and increased ¹⁸F-FDG transport [6]; other authors attribute this to overexpression of hexokinase-2, a key enzyme in the glycolytic pathway in tumor cells [7]. We believe that the role of enhanced ¹⁸F-FDG uptake of GCTB should be mentioned in an overview such as that reported by van der Heijden et al. [1], with regard not only to the response to denosumab treatment for unresectable GCTB [8] but also to the clinical implications for in the diagnosis of this disease [3, 9].Open in a separate windowFigure 1.Positron emission tomography/computed tomography showing enhanced F-18 fluorodeoxy-D-glucose uptake at the level of the proximal end of the right fibula.     

骨巨细胞瘤的临床、X线、病理观察与分期探讨

目的评价骨巨细胞瘤的临床、X线、病理观察及三结合综合分期的意义。方法收集经手术病理证实的骨巨细胞瘤78例,以其临床、X线、病理特征为依据,进行临床分症、X线分型、病理分级三结合回顾性观察分析,将骨巨细胞瘤综合分为三期。结果三项均符合者64例,占82％。对Ⅰ、Ⅱ期的治疗选择刮除烧灼加植骨,对部分见期采用瘤体整块切除加植骨治疗共56例,随访5年4例复发。对Ⅲ期患者采取截肢或瘤体整块切除加骨水泥充填,5年生存率达50％。结论骨巨细胞瘤的三结合综合分期,对确定其属性和程度,正确估计预后和选择适当的治疗方案有重要的临床意义。     

骨巨细胞瘤26例临床病理分析

目的 :探讨骨巨细胞瘤分级治疗的临床意义与鉴别诊断。方法 :按Jaffe分级 ,2 6例中 ,Ⅰ级12例 ,Ⅱ级 11例 ,Ⅲ级 3例 ,术后随访 16例 ,Ⅰ级 7例 ,Ⅱ级 6例 ,Ⅲ级 3例。结果 :7例复发 ,Ⅰ级 3例 ,Ⅱ级 3例 ,Ⅲ级 1例 ,复发率Ⅰ级 4 2 .86% ,Ⅱ级 50 % ,Ⅲ级 33.33% ,Ⅱ、Ⅲ级肺转移各 1例。结论 :分级与复发无明显关系 ,与远处转移有关