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目的探讨胸内孤立性纤维瘤(solitary fibrous tumor,SFT)的影像学表现,提高对该病的诊断和鉴别诊断水平。资料与方法回顾性分析3例经手术病理证实的胸内SFT的临床、影像学及病理资料。3例均行螺旋CT平扫与增强扫描,其中2例行多平面重组(multi-planar reformatting,MPR),1例行MRI平扫;结合文献探讨胸内SFT的影像学表现。结果 3例胸内SFT分别位于肺内、斜裂胸膜、后胸壁脏层胸膜,肿块均为孤立肿块。1例左下叶背段外周肿块CT平扫为界限清楚软组织肿块,增强扫描动脉期肿块内见“簇”状、“线”状强化小血管影,延时扫描肿块呈非均匀强化,部分实性成分呈渐进性强化;MR T1WI上肿块呈稍短T1信号,T2WI上呈“地图”样高低混杂信号,以短T2信号为主;1例斜裂肿块平扫表现为“卵圆”形边缘光滑均质软组织密度肿块,增强扫描呈中度均匀强化;1例后胸壁脏层胸膜肿块CT平扫为非均质肿块,增强后肿块呈轻度类环状强化,内部见大片非强化坏死区,邻近见“贴边血管征”。3例均未见肺门和纵隔淋巴结肿大,手术病理结果示肿块界限清楚,有包膜或假包膜。镜下肿瘤细胞为长梭形,细胞排列成“束”状、“漩涡”状或“不规则”状,细胞密集区与疏松区交替出现,可见粗大的“瘢痕”样玻璃变性的胶原纤维相间,部分视野可见血管外皮瘤样结构,1例左下叶背段病变示陷入的细支气管及肺泡上皮。免疫组织化学检查:CD34或CD99、癌基因(Bcl-2)、波形蛋白(Vimentin)均呈强阳性。结论胸内SFT少见,其影像表现具有相对特征性,确诊需依靠病理组织学及免疫组织化学检查。
Objective To investigate the imaging findings of solitary fibrous tumor (SFT) and to improve the diagnostic and differential diagnosis of the disease. Materials and Methods Retrospective analysis of 3 cases of thoracic SFT confirmed by surgery and pathology clinical, imaging and pathological data. Three patients underwent spiral CT scan and enhanced scan. Two patients underwent multi-planar reformatting (MPR) and one patient underwent plain MRI scan. The imaging findings of intrathoracic SFT were discussed in combination with the literature. Results Three cases of intrathoracic SFT were located in the lungs, obliquely inflated pleura, visceral pleura in the posterior chest wall, and the lumps were isolated lumps. One case of the lower left posterior segment of the peripheral mass CT scan as a clear boundary of the soft tissue mass, enhanced scan arterial phase see “cluster ” shape, “line ” shape of small blood vessels, delayed scan mass heterogeneity , Part of the solid ingredients were progressive enhancement; MR T1WI showed a slightly shorter T1 signal on the T1WI, T2WI showed “Map ” like high and low mixed signals, mainly short T2 signal; 1 cases of oblique plaques showed “Oval ” edge smooth homogeneous soft tissue density mass, enhanced scanning was moderately uniform enhancement; 1 case of chest wall visceral pleural mass CT scan for heterogeneous mass, enhanced mass showed mild ring-like enhancement, Internal see a large area of non-intensive necrosis, near see “Vascular edge ”. No cases of hilar and mediastinal lymph nodes were found in 3 cases. The pathological results of the operation showed clear boundary of the tumor with capsule or pseudocapsule. Microscopically, the tumor cells were long fusiform, and the cells were arranged in “beam” shape, “swirl” shape or “irregular” shape. The cell dense area alternated with the loose area, showing the thick “scar” "Degeneration of collagen fibers like glass, part of the visual field can be seen vascular endothelial tumor-like structure, a case of left lower lobe back lesions showed trauma into the bronchial and alveolar epithelium. Immunohistochemistry: CD34 or CD99, oncogene (Bcl-2), vimentin (Vimentin) were strongly positive. Conclusion The intrathoracic SFT is rare, and its imaging features are relatively characteristic. The diagnosis depends on histopathology and immunohistochemistry.