骨韧带样纤维瘤的影像学表现及病理对照

目的：探讨骨韧带样纤维瘤（desmoplastic fibroma）的影像学表现及病理对照。方法：回顾性分析11例骨韧带样纤维瘤患者的临床特征、X线、CT、MRI及病理表现，并复习文献。结果：11例骨韧带样纤维瘤，1例位于锁骨，3例位于尺骨、桡骨，2例位于胫骨，2例位于髂骨，1例位于第1-第3跖骨，2例位于下颌骨，1例伴有病理性骨折。x线平片示骨质溶骨性膨胀性改变，其内见根须样肿瘤性骨小梁，灶内无骨化，灶边缘无硬化，骨皮质变薄，无骨膜反应。CT平扫病灶密度稍低于邻近肌肉组织，无坏死及骨化，邻近骨皮质变薄，内缘凹凸不平，呈粗大的骨嵴。MRI检查病灶在T1WI上呈等于肌肉组织信号，在T2WI上呈高于肌肉组织低于脂肪组织信号，其内可见条状或带状T2WI低信号。组织学上肿瘤组织内梭形成纤维细胞呈束状、编织状排列，偶见核分裂，细胞间可见胶原组织包绕。结论：本病以骨膨胀性改变，根须样肿瘤性骨小梁，无骨化及骨膜反应为基本X线表现，根须样肿瘤性骨小梁具有一定特征性。病灶内在T2WI上条带状低信号是其特征性而非特异性的MRI表现。

Imaging characteristics and pathological comparison of desmoplastic fibroma of bone

Objective： To investigate the imaging and pathologic characteristics of desmoplastic fibroma of bone. Methods： Clinical and imaging features of eleven cas＇s of desmoplastic fibroma were analysised compared with pathologic results and relevant documents were studied retrospectively. Results： Of eleven cases of desmoplastic fibroma, one case occurred in clavicle, three in ulna and radius, two in tibia, two in ilium, one in the lst-3rd metatarsal, two in mandible, and one of them was recurrence, and one of them was associated with a pathologic fracture. In plain film, osteolytic and expansile changes of bone were revealed, within which root-like tumoral trabeculae could be found, however, ossifications and hardening margins were absent. Cortices of bone nearby were thinning without periosteal reactions. CT examinations revealed that densities of lesions were slightly lower than that of muscle tissues adjacent, without necroses and ossifications. Cortices of bone nearby were thinning, with rugged inner edges which were just like thick trabeculae. MR examinations showed that signals of lesions were equal to that of muscle tissues on T1WI, whereas higher than that of muscle tissues and lower than that of fatty tissues on T2WI. Within lesions, strip or ribbon low-intensity signals could be seen. Histologically, DTs were composed of fibroblasts and myofibroblasts that were uniformed in appearance with rare mitoses, surrounded by abundant collagen. Conclusion： Expansile changes without ossifications and periosteal reactions, boot-like tumoral trabeculae are the basic X-ray findings, and root-like tumoral trabeculae have a certain characteristic. Strip or ribbon hypointensity signals within lesions are a characteristic rather than specific MRI finding on T2WI lesions.