课件：孤立性纤维性肿瘤影像诊断.ppt

胸部孤立性纤维性肿瘤 胸膜外孤立性纤维肿瘤 Solitary Fibrous Tumor of the Pancreas a. Triphasic CT of the pancreas reveals a 5cm solid mass arising from the body of the pancreas. b.Cell block HE stain from the fine needle aspirate specimen showed bland appearing spindle cells (40x). c. Vimentin immunohistochemical stain of the cell block specimen with tumor cells that have strong positivity (40x). d. Pancreatic resection specimen demonstrated a 5.0x5.0x4.5 cm well circumscribed non-encapsulated mass (arrow) present in the body of the pancreas, which is shown bisected. e. HE stain of the resected tumor revealed spindle cells in a variably collagenous background with minimal cytologic atypia and rare mitotic activity (40x). f. Bcl-2 immunohistochemical stain of the resected mass with tumor cells that have strong positivity (40x). Solitary Fibrous Tumor of the Liver Computed tomography image, with arrows pointing at the junction between the tumour and normal liver. Computed tomography of the abdomen, with an arrow pointing at the lesion. Solitary Fibrous Tumor of the Kidney Contrast computed tomography scan demonstrating an enhanced, well-demarcated tumor of the left kidney with multinodular configuration. The tumor involved the renal cortex and perirenal adipose tissue 左肾上方较大软组织肿块，呈不规则性强化，可见内部坏死区 Solitary Fibrous Tumor of the Larynx A 34-year-old man was referred to our hospital because of a foreign body sensation in the throat for six months. A fiberoptic laryngoscopy revealed a 3.5 cm diameter smooth submucosal mass on the right side of the supraglottic larynx 鉴别诊断 血管外皮细胞瘤：MR T2WI多呈略高信号。缺乏SFT致密胶原纤维形成的低信号，坏死区几乎见于所有肿瘤，且坏死显著；动态增强肿瘤强化显著。少数SFT与血管外皮细胞瘤影像学征象有重叠。 滑膜肉瘤：不仅病理和组织学方面与孤立性纤维瘤有重叠，且滑膜肉瘤T2期呈等或略高信号，动态增强中等程度强化，与SFT影像表现相仿。滑膜肉瘤一般位于关节邻近，肿瘤钙化常见。此外，滑膜肉瘤内常见形态规则的囊变和出血，邻近骨骼常见侵蚀。 肌肉淋巴瘤：来源于单一细胞的肌肉淋巴瘤，细胞排列密集，MR T2WI一般呈略高或等信号，肿瘤内可见血管流空，因此，与SFT容易混淆。但肌肉淋巴瘤境界多不清楚。边缘常见“羽毛征”。淋巴瘤内血管为包绕的体内正常血管，而非真正的肿瘤血管，故血管形态多正常。 总之，SFT肿瘤密实，境界清楚，瘤内可见两种不同密度的软组织成分，T2WI多表现为略高信号信号中夹杂片状低信号区，密度或信号相对均匀，动态增强多呈中等程度强化。