摘要
目的探讨钙化性纤维性肿瘤(CFT)的影像学及临床病理特征,以提高对CFT的认识。方法选取9例经病理诊断为CFT患者的影像学及临床病理资料并复习文献。结果9例CFT中,2例行胃镜检查,3例行超声检查,2例行CT检查,1例行MRI检查,所有患者均行常规HE染色及免疫组化染色。9例CFT患者,3例为体检时通过影像学或内镜检查被发现,3例因肿瘤手术时被偶然发现。4例伴发其他肿瘤,分别为卵巢支持-间质细胞瘤、直肠腺癌、宫颈鳞状细胞癌及肝脏血管瘤,其中3例为恶性肿瘤。3例CFT超声检查均呈低回声团块,边界清,内回声不均,内部血流信号通常不明显,其中1例可探及散在强回声斑。2例CFT行CT平扫,肿块均呈低密度,边界清晰,无坏死及囊变,增强扫描分别呈逐渐轻度强化和明显不均匀强化,肿块内均可见不规则点状钙化。1例MRI表现为T1WI不均匀低信号,T2WI不均匀高信号,内部间杂不规则低信号,增强扫描呈不均匀弱强化,FLAIR不均匀高信号,DWI肿瘤未见扩散受限,呈低信号。CFT显微镜下特点为大量胶原玻璃样变的纤维组织内伴有营养不良性钙化或砂砾体形成,其间夹杂稀疏的梭形纤维母细胞,间质内可见散在的淋巴细胞和浆细胞浸润。免疫组化显示瘤细胞表达Vimentin。结论CFT的诊断应结合影像学表现、组织学形态及免疫组化综合分析,对术中发现的肿瘤周围结节行术中快速冰冻检查明确其性质,有助于肿瘤的临床分期及手术范围的选择。
Objective To investigate the imaging and clinicopathological features of calcifying fibrous tumor(CFT)in order to improve the clinicians'and pathologists'better understanding of CFT.Methods The imaging and clinicopathological data of 9 patients with CFT diagnosed by pathology were analyzed retrospectively,and the relative literatures were reviewed.Results In 9 cases of CFT,2 cases were examined by gastroscopy,3 cases by ultrasonography,2 cases by CT,and 1 case by MRI.All patients were stained by HE and immunohistochemistry.Among the 9 patients,3 cases of CFT were found by imaging or endoscopy during physical examination and 3 cases by accident during tumor operation.4 cases were accompanied by other tumors,including ovarian Sertoli-stromal cell tumor,rectal adenocarcinoma,cervical squamous cell carcinoma and liver hemangioma,3 of which were malignant.Two cases of CFT in the stomach were found by white light endoscopy and narrow-band imaging combined with magnifying endoscopy.Three cases of CFT showed hypoechoic mass with clear boundary,uneven internal echo,and usually not obvious internal blood flow signal during ultrasonic examination,and in one of them,scattered hyperechoic spots could be detected.Two cases of CFT underwent CT scan.The masses showed low density,clear boundary,no necrosis or cystic change in plain CT scan.The enhanced scan showed gradual slight enhancement and obvious uneven enhancement,respectively,and irregular dotted calcification was found in the masses.One case of MRI showed heterogeneous low signal on T1WI,heterogeneous high signal on T2WI with irregular low signal on internal,heterogeneous weak enhancement on enhanced scan,heterogeneous high signal on FLAIR,and low signal with no diffusion limitation on DWI.Under the microscope,a large number of collagen glass like fibrous tissues were accompanied by dystrophic calcification or psammomatous body formation,with sparse spindle fibroblasts and scattered lymphocytes and plasma cells infiltration in the stroma.Immunohistochemistry showed vimentin expression in tumor cells.Conclusion The diagnosis of CFT should be combined with the comprehensive analysis of imaging,histologic morphology and immunohistochemistry.The frozen examination of the peri-tumor nodule found during the operation can help make clear its nature,which is useful for the determination of clinical stage and operation scope of the tumor.
作者
宋沙沙
徐银涛
刘玉波
徐嘉雯
王强修
SONG Shasha;XU Yintao;LIU Yubo;XU Jiawen;WANG Qiangxiu(Department of Pathology, Shandong Maternal Child Health Hospital Affiliated to Shandong University, Jinan 250014, P.R.China;Department of Obstetrics and Gynecology, QILU Hospital of Shandong University, Jinan, 250012, P.R.China;Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R.China;Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R.China)
出处
《医学影像学杂志》
2020年第11期2099-2103,共5页
Journal of Medical Imaging
基金
山东省自然科学基金项目(编号:ZR2017QH008)
山东省重点研发计划项目(编号:2015GSF118015)。
关键词
钙化性纤维性肿瘤
影像学诊断
免疫组化
Calcifying fibrous tumor
Imaging danograsis
Immunohistochemistry
