四肢良性纤维组织细胞瘤的影像与病理对照研究

目的探讨四肢良性纤维组织细胞瘤(BFH)的影像学表现与病理特点,从而提高影像诊断的准确性。方法选取21例经手术病理证实的原发长骨良性纤维组织细胞瘤患者的临床表现及影像学资料,其中19例位于下肢,2例位于肱骨。MRI检查13例,CT检查11例,X线摄影检查9例。结果大部分病例呈不同程度膨胀性改变,边缘可见完整或不完整硬化边,少数膨胀不明显。X线摄影表现中7例伴有骨皮质变薄,1例骨皮质中断,3例病灶内可见骨性分隔和骨嵴。CT表现中大部分密度尚均匀,3例密度不均,可见斑片状高密度影,5例病灶内可见骨性分隔或骨嵴,5例病灶边缘可见扇贝样压迹,1例伴有病理性骨折;MRI因肿瘤内部成分不同而表现多样,大部分T₁WI呈等低信号,T₂WI呈稍高信号或混杂高信号;6例病灶周围可见不同程度骨髓及软组织水肿征象;镜下表现为旋涡状排列的梭形纤维母细胞,内可见泡沫细胞和多核巨细胞。结论 BFH好发于四肢长骨,影像表现具有一定特征性,其影像学表现与病理密切相关,综合分析临床和影像学特征,可提高其诊断准确性。

A comparative study of imaging and pathology of benign fibrous histiocytoma of the extremities

Objective To investigate the imaging features and pathological characteristics of benign fibrous histiocytoma(BFH),so as to improve the accuracy of imaging diagnosis.Methods The clinical manifestations and imaging data of 21 patients with primary benign fibrohistioma of long bone confirmed by surgery and pathology were retrospectively analyzed,including 19 cases in the lower extremity and 2 cases in the humerus.MRI examination was performed in 13 cases,CT examination in 11 cases and X-ray examination in 9 cases.Results Most of the cases showed varying degrees of dilatation,with intact or incomplete sclerotic edges visible at the edges,and a few without obvious swelling.X-ray findings showed that 7 cases were accompanied by cortical thinning,1 case had cortical disruption,and 3 cases had bony septum and ridge in the lesions.In CT findings,most of the density was still uniform,with uneven density and patchy high-density shadows in 3 cases,bone septum or bone crest in 5 cases,scallop-like pressure marks in the edge of 5 cases,and pathological fracture in 1 case.MRI showed a variety of manifestations due to different internal components of the tumor,most of which presented isolow signal on T1WI and slightly high signal or mixed high signal on T2WI.Edema of bone marrow and soft tissue was observed in 6 cases.Microscopically,spindle fibroblasts with foam cells and multinucleated giant cells are seen in a spiral arrangement.Conclusion BFH often occurs in the long bones of the limbs,with certain imaging characteristics,and its imaging manifestations are closely related to pathology.Comprehensive analysis of clinical and imaging characteristics can improve its diagnostic accuracy.