脊柱肿瘤知识讲座.ppt

脊索瘤 临床病理 少见，起源于脊索残余，占骨病变不到4% 50%于骶骨（主要S4-S5），其次35%斜坡，15%椎体（主要C2）.也为骶骨最常见的原发骨肿瘤 肿瘤呈分叶状，有纤维假包膜，内含灰白或浅黄色胶状物；可出血、假囊腔以及肉芽样组织 肿瘤生长缓慢，局部侵袭性，不转移,偶远处转移, 主要为肺、淋巴结、蛛网膜下腔和脊髓 多男性，男：女=2-3 :1；30-60岁，高峰年龄50岁 症状多由肿瘤扩大侵犯或压迫邻近重要组织或器官所引起治疗以手术切除为主 脊索瘤 影像表现 X线 肿瘤为溶骨性破坏，伴大的软组织肿块 骶椎患骨常膨胀，瘤内50-70%见钙化 钙化多无定形，位于病变周围 骶椎以上节段患骨较少膨胀改变，并可出现硬化呈“象牙椎”表现 脊索瘤 影像表现 CT 主要呈溶骨性破坏 肿瘤分叶状，囊实性混杂密度，可见不规则钙化 软组织肿块 增强，轻至中度强化 不易与转移瘤鉴别 脊索瘤 影像表现 MR T1WI：中等信号（占75% ） ；低信号（占25% ） T2WI：呈高信号，信号高于CSF 增强：明显强化 MRI在显示病变侵及的范围方面优于CT CT在确定肿瘤的性质特点方面优于MRI Fig.ALateral radiograph shows destruction of the distal sacrum and coccyx with calcification (arrow). Fig.BCT scan also demonstrates the bone destruction and a soft-tissue mass (arrowheads) containing calcifications (arrow). . Chordoma of lower sacrum 48-year-old man Fig.A Fig.B 脊索瘤 Fig.C T1WI Sagittal and axial T2WI Fig.DMR images reveal the expansile sacrococcygeal lesion (arrowheads), which has high signal intensity on D. Fig.C Fig.D 脊索瘤 Fig.E As seen in this sagittal section of the gross specimen, the MR imaging appearance correlates with the expansile lesion (arrowheads) and calcification (arrow). The upper sacrum (*) is spared 脊索瘤 Fig.ALateral radiograph shows a dense vertebral body (arrows) at L-3. Fig.BSagittal reconstructed CT scan obtained after initial open biopsy reveals not only the L-3 sclerosis but also similar findings in the superior aspect of L-4 (arrowheads). Chordoma of L 13-year-old man 1-yr history of intermittent low back pain. Fig.A Fig.B 脊索瘤 Sagittal T1WI Fig.Cand T2WIFig.D MR images better delineate the marrow involvement at L-3 and L-4 with extension through the disk (arrows). The mass has marked high signal intensity on d. Fig.C Fig.D Fig.E gross specimen depicts the extent of the neoplasm, with diffuse involvement of L-3 (arrowheads), the adjacent disk (*), and the superior aspect of L-4 (arrows). Fig.E 脊索瘤 Upper Left and Right: Axial CT scans demonstrating a large soft-tissue mass extending anteriorly to involve the rectum a