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目的探讨骨原发性恶性纤维组织细胞瘤(BMFH)影像表现及诊断要点。方法回顾性分析6例经病理确诊为BMFH的X线、CT及MRI表现。结果4例侵犯单骨,2例侵犯多骨。溶骨型4例,混合型2例。股骨下端3例,肱骨上端1例,楔骨1例,横突1例,共侵犯12个骨骼。6例均有骨及骨皮质明显破坏,以溶骨性破坏为主,2例病灶周围有轻度骨硬化。全部病例均有软组织肿块,巨大肿块2例,局限性肿块4例,1例肿块内可见散在小钙化影。全部病例未见骨膜反应,3例合并病理性骨折。结论原发性BMFH好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端。虫蚀状或大片状溶骨性骨质破坏,巨大软组织肿块,无骨膜反应,是其影像学特点,诊断需密切结合临床和病理。
Objective To investigate the imaging features and diagnosis of primary malignant fibrous histiocytoma (BMFH). Methods Retrospective analysis of 6 cases of pathologically diagnosed as BMFH X-ray, CT and MRI findings. Results 4 cases of infiltration of a single bone, 2 cases of violations of bony. 4 cases of osteolytic type, mixed type in 2 cases. 3 cases of the lower femur, 1 case of upper humerus, 1 case of wedge, 1 case of transverse process, involving a total of 12 bones. 6 cases were significantly damaged bone and cortical bone to osteolytic destruction, 2 cases of lesions around mild osteosclerosis. All cases had soft tissue mass, huge mass in 2 cases, 4 cases of localized mass, and 1 mass showed small scattered calcification. No cases of periosteal reaction in all cases, 3 cases with pathological fracture. Conclusions Primary BMFH occurs predominantly in the metaphysis of the long bone or in the distal part of the bone. It is more common in the lower femur and the upper part of the tibia. Etch-like or large lamellar osteolytic bone destruction, a huge soft tissue mass, no periosteal reaction, is its imaging features, diagnosis should be closely combined with clinical and pathological.