胸膜-肺滑膜肉瘤的影像学表现及病理特征

目的探讨胸膜-肺滑膜肉瘤的影像学表现,提高对该病的诊断能力。方法回顾性分析6例胸膜-肺滑膜肉瘤的临床、影像及病理资料,6例均行X线检查、5例行CT检查、2例行MRI检查。结果 X线示肺部均见较大或巨大的占位,范围约3cm×3cm×1.5cm-15.3cm×22.5cm×16.9cm。CT示肿瘤均为周围型,部分边缘光整,密度不均,内未见钙化,增强后5例均呈明显不均匀强化,3例侵及邻近叶间裂或胸膜。CT均未见肺门及纵隔淋巴结肿大;MRI示T1WI呈稍低信号,T2WI呈稍高信号,增强后肿块轻度不均匀强化。术后病理示淋巴结均未见肿瘤转移。免疫组织化学结果显示波形蛋白(Vim)、细胞角蛋白(CK)、上皮膜抗原(EMA)阳性。结论胸膜-肺原发性滑膜肉瘤的影像表现具有相对特征性表现,了解影像学表现有助于临床手术方案的制定及预后指导,确诊需要依靠病理及免疫组化。

Imaging Characteristics and Pathologic Features of Pleuropulmonary Synovial Sarcoma

Objective To evaluate the imaging characteristics of PPSS (Pleuropulmonary synovial sarcoma, PPSS) and improve its diagnosis.Methods The clinical, imaging and pathology findings of 6 patients were retrospectively analyzed.All 6 patients received X-ray and 5cases had CT scan, 2 cases had MRI.Results Enormous mass in lungs were found in X-ray and their scope were 3cm×3cm×1.5cm to 15.3cm×22.5 cm×16.9cm. Peripheral tumors which showed clear margin partly will inhomogeneous density, was found in CT scan, and no calcification in the lesion. On the contrast-enhanced CT scan, 5 cases were inhomogeneous enhancement. Pleural or interlobar fissure invasion were detected in 3 patients. No llilar or mediastinal lymph nodes metastasis were seen in all cases. MRI showed T1WI were slightly low signal, T2WI were slightly high signal, the mass had mild heterogeneous enhancement.Lymph node metastasis was not found in pathologic. The immunohistochemical examinations of Vim, CK and EMA were positive in 6 patients.Conclusion There are some relatively specific imaging findings of primary pulmonary synovialsarcoma. Understand imaging findings will help clinical surgery and prognosis guidance, accurate diagnosis depends on pathology and immunohistochemistry.