孤立性纤维性肿瘤超声造影和病理学诊断特征分析

目的探讨孤立性纤维性肿瘤超声造影和病理学的诊断特征。 方法回顾性分析2015年1月至2019年12月青岛市市立医院经手术与病理证实的6例孤立性纤维性肿瘤患者的超声造影和病理学资料，总结其诊断学特征。 结果6例患者中，男性3例，女性3例，年龄32～65岁，1例位于腹壁，1例位于足背，1例位于眼眶，2例位于胸壁，1例位于乳腺。6例孤立性纤维性肿瘤二维超声表现为边界清楚或不清、边缘光滑的低回声或中等或混合回声肿块，4例呈椭圆形，2例呈圆形；2例回声欠均匀伴液化，4例回声较均匀；4例可见丰富的分支状血流信号，血管阻力较小。超声造影均呈动脉期均匀性或不均匀性高增强，2例病灶增强范围较常规超声增大，4例病灶增强范围较常规超声无明显增大，延迟期无明显廓清，呈略高增强。6例均经手术切除，4例可见完整包膜，2例与周围组织界限不清；4例有丰富的血管供应，2例可见坏死液化区，4例质韧，2例质地中等。术后常规苏木精-伊红(HE)染色示间叶组织来源肿瘤，瘤细胞呈梭型，围绕血管生长，呈旋涡状或索状，细胞聚集区与稀疏区交替分布；肿瘤细胞分布不均，间质内见粗细不等红染的胶原纤维及丰富树枝状薄壁血管；4例核有轻度异型性，核分裂象少见，2例核有中度异型性，核分裂象多见。免疫组化结果示：CD34阳性(4/6)，B淋巴细胞瘤2(Bcl-2)阳性(5/6)，波形蛋白(Vimentin)阳性(5/6)，CD99阳性(6/6)，平滑肌肌动蛋白(SMA)阳性(4/6)，S100阴性(6/6)，符合孤立性纤维性肿瘤的诊断。 结论孤立性纤维性肿瘤的超声造影和病理学具有一定的特征性，有助于其诊断。

Contrast-enhanced ultrasonography and pathological analysis of solitary fibrous tumors

ObjectiveTo investigate the diagnostic features of ultrasonography and pathology of solitary fibrous tumors (SFT). MethodsContrast-enhanced ultrasonography and pathology data of 6 patients with solitary fibrous tumor (SFT) confirmed by surgery and pathology in Qingdao Municipal Hospital from January 2015 to December 2019 were retrospectively analyzed, and the diagnostic characteristics were summarized. ResultsThree cases were male, and three cases were female in six patients. The ages range from 32 to 65. One case was located in the abdominal wall, 1 case was located in the foot dorsum, 1 case was located in the eye socket, 2 cases were located in the chest wall and 1 case was located in mammary gland. The two-dimensional ultrasonographic manifestations of 6 cases of SFT were hypoechoic, moderate or mixed echogenic masses with clear or unclear boundaries and smooth edges. 4 cases were oval, 2 cases were round, 2 cases had non-uniform echo with liquefaction, 4 cases had relatively uniform echo, 4 cases had abundant branching blood flow signals, and the vascular resistance was small. Contrast-enhanced ultrasonography showed high enhancement of uniformity or unevenness in the arterial phase, 2 cases showed increased lesion enhancement range compared with conventional ultrasound, 4 cases showed no significant increase in lesion enhancement range compared with conventional ultrasound, and there was no significant clearance in the delayed phase, showing slightly higher enhancement. All tumors of the 6 cases were surgically removed, 4 cases had complete capsule, 2 cases had unclear boundary with surrounding tissue, 4 cases had abundant vascular supply, 2 cases had necrotic liquefaction zone, 4 cases had ductile, 2 cases had medium texture. Postoperative routine HE staining: source of mesenchymal tissue tumors and tumor cells showed spindle type, around blood vessel growth, a spiral or funicular, cell clusters alternating with sparse area distribution of tumor cell distribution. Unequal thickness and red color of collagen fibers and abundant dendritic parenchyma vessels were found in the interstitium. Four cases of nuclear had mild atypia and few mitotic, while 2 cases of nuclear had moderate atypia and visible mitotic. Immunohistochemical results: CD34 positive (4/6), Bcl-2 positive (5/6), Vimentin positive (5/6), CD99 positive (6/6), SMA positive (4/6). S100 negative (6/6), consistented with the the diagnosis of SFT. ConclusionContrast-enhanced ultrasonography and pathology of SFT have certain characteristics, which are helpful for their diagnosis.