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目的探讨隆突性皮肤纤维肉瘤(DFSP)的超声、CT和MRI表现及其病理基础。方法回顾性分析经手术病理证实的13例DFSP患者的影像学资料及病理结果,其中5例行超声检查,5例行CT扫描(增强3例),6例行MRI平扫+增强检查。结果 13例病灶均位于皮下浅表,超声表现为欠均匀低回声肿块,彩色多普勒示病灶内部血流信号丰富;CT平扫均呈等密度;T_1WI呈等信号或略低信号,T_2WI呈稍高信号。CT或MRI增强呈明显不均匀强化,内见条片状弱或不强化区;病理镜下见肿瘤细胞围绕血管呈席纹状密集排列,胶原纤维呈旋涡状排列,3例瘤体内见黏液样变区,2例伴纤维肉瘤样变区,免疫组织化学CD34均呈阳性。MRI上瘤体直径>5 cm的8例中,5例见“周围卫星灶”(4例术后复发)。结论 DFSP影像表现多呈均匀等密度/信号、明显不均匀强化,不强化区域与旋涡状排列的胶原纤维有关,密度不均匀的病理基础是黏液样变或肉瘤样变,当发现肿瘤体积增大、瘤周“周围卫星灶”时,术后易复发,适当扩大切除范围是必要的。
Objective To investigate the ultrasonographic, CT and MRI features of the dermatofibrosarcoma (DFSP) and its pathological basis. Methods The imaging data and pathological findings of 13 DFSP patients confirmed by surgery and pathology were analyzed retrospectively. Among them, 5 cases underwent ultrasound examination, 5 cases underwent CT scan (enhanced in 3 cases) and 6 cases underwent MRI scan and enhanced examination. Results Thirteen lesions were located in the superficial subepithelial surface. The ultrasound showed under-uniform hypoechoic mass. The color Doppler showed rich internal blood flow signals. CT scan showed equal density. T_1WI showed equal or slightly lower signal. The T_2WI Slightly higher signal. CT or MRI enhancement was significantly uneven enhancement, see the flaky weak or no enhancement zone; pathological microscopic examination of tumor cells around the blood vessels were arranged in rows dense pattern, collagen fibers were swirling arrangement, three cases of mucus-like tumor Variations, 2 cases with fibrosarcoma-like area, immunohistochemistry CD34 were positive. Of the 8 cases with tumors> 5 cm in diameter, 5 were found in the “surrounding satellites” (4 postoperative recurrences). CONCLUSIONS: The DFSP images showed mostly uniform isodense / signal intensity with markedly non-uniform enhancement. The area of non-enhancement was related to collagen fibers arranged in a spiral pattern. The pathological basis of uneven density was mucoid change or sarcomatoid change. When the volume of tumor was increased , Tumor week “around the satellite stove ”, the postoperative easy to relapse, the appropriate expansion of the excision range is necessary.