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中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (02) : 81 -85. doi: 10.3877/cma.j.issn.2095-655X.2016.02.003

所属专题: 文献

影像学诊断研究

下肢肌间弥漫性腱鞘巨细胞瘤的诊断学特征分析
王泽1, 孟德华1, 徐沁同1, 张键1,()   
  1. 1. 200032 上海,复旦大学附属中山医院骨科
  • 收稿日期:2015-11-23 出版日期:2016-05-26
  • 通信作者: 张键

Diagnostics features of diffuse-type giant cell tumor of the tendon sheath manifestation within muscle in one lower limb

Ze Wang1, Dehua Meng1, Qintong Xu1, Jian Zhang1,()   

  1. 1. Department of Orthopedics Surgery, Shanghai Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
  • Received:2015-11-23 Published:2016-05-26
  • Corresponding author: Jian Zhang
  • About author:
    Corresponding author: Zhang Jian, Email:
引用本文:

王泽, 孟德华, 徐沁同, 张键. 下肢肌间弥漫性腱鞘巨细胞瘤的诊断学特征分析[J]. 中华诊断学电子杂志, 2016, 04(02): 81-85.

Ze Wang, Dehua Meng, Qintong Xu, Jian Zhang. Diagnostics features of diffuse-type giant cell tumor of the tendon sheath manifestation within muscle in one lower limb[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(02): 81-85.

目的

探讨临床表现为下肢肌肉内孤立性病变的弥漫性腱鞘巨细胞瘤的临床诊断学特征。

方法

回顾性分析1例临床表现为左下肢关节外孤立性病变的弥漫性腱鞘巨细胞瘤患者的临床资料,并复习相关文献。

结果

患者临床表现为左下肢进行性增大的无痛性肿块,血液、生化、免疫检查等实验室检查无异常发现。超声及血流多普勒检查示左侧大腿根部实性占位,内部血流信号丰富,电子计算机断层扫描示左大腿根部实性占位,下肢磁共振检查示肌间肉瘤病灶,正电子发射断层显像/X线计算机体层成像示局部氟化脱氧葡萄糖异常浓聚。手术行包膜外正常组织内完整切除肿块,术后病理检查结合术中病灶生长方式明确为弥漫性腱鞘巨细胞瘤。

结论

弥漫性腱鞘巨细胞瘤可以表现为肢端孤立的关节外占位性病变,影像学检查极易因其特殊的生长方式及内部结构而倾向于恶性结果,完整的手术切除及病理学检查可以对该类病变进行治疗并明确病因。

Objective

To explore the diagnostic features of diffuse-type giant cell tumor of the tendon sheath manifestation with solitary mass within muscle in one lower limb.

Methods

The clinical data of one patient with diffuse-type giant cell tumor of the tendon sheath manifestation with solitary mass within muscle in one lower limb was retrospectively studied, and the relevant literatures were reviewed.

Results

The patient presented with a progressively enlarging mass within muscle in left lower limb.Blood test, biochemical test, immunologic test showed no abnormalities.Ultrasound and Doppler scan demonstrated a solid lesion in the left thigh with rich blood supply signals inside.Computerd tomograph (CT) reconstruction images revealed a solid and homogenous mass.Meanwhile, MR test suggested a sarcomatoid change.Positive PET/CT findings showed locally abnormal accumulation of F-18 FDG, indicating a malignant lesion.Total resection around the mass with clear margin were carried out, and pathologic examination combined with growth patten of mass proved to be diffuse-type giant cell tumor of the tendon sheath.

Conclusions

Diffuse-type giant cell tumor of the tendon sheath can present as a solitary extra-articular mass in limbs and is easily considered to be malignant when combined with special imaging manifestation because of its growth patten and inner constructure.Correct diagnosis and reasonable treatments can be made by pathologic examination after total resection.

图1 下肢弥漫型腱鞘巨细胞瘤患者病变区超声及血流多普勒检查图像。见低回声团块影(白箭头所示),回声不均匀,内部及边缘见较多血流信号
图2 下肢弥漫型腱鞘巨细胞瘤患者病变区磁共振T1加权图像。见左侧大腿内侧团块状异常信号灶,T1加权像上呈低信号(白箭头所示)
图3 下肢弥漫型腱鞘巨细胞瘤患者病变区磁共振T2加权图像。见左侧大腿内侧团块状异常信号灶,T2加权像上呈高信号(白箭头所示)
图4 下肢弥漫型腱鞘巨细胞瘤患者病变区磁共振增强扫描图像。示病变呈明显不均匀强化表现,内部信号不均匀(白箭头所示)
图5 下肢弥漫型腱鞘巨细胞瘤患者病变区电子计算机断层扫描图像。示左大腿根部实性占位(白箭头所示)
图6 下肢弥漫型腱鞘巨细胞瘤患者病变区正电子发射断层显像/X线计算机体层图像扫描图像。示左大腿病变区核素浓聚(白箭头所示)
图7 下肢弥漫型腱鞘巨细胞瘤患者全身电子计算机断层扫描图像。示左大腿局部核素异常浓聚(白箭头所示)
图8 下肢弥漫型腱鞘巨细胞瘤患者病灶切除标本光镜下图像。a图示瘤体包膜1 cm外行完整切除,见瘤体外脂肪组织(白箭头所示)、肌组织(黑箭头所示)(HE ×50);b图示瘤体外包膜形成,瘤内见散在多核巨细胞(黑箭头所示)、大量炎症细胞浸润(HE ×100);c图示瘤内可见假腺管样结构形成,并见大量含铁血黄素沉积伴胶原沉积(黑箭头所示)(HE ×100);d图示瘤内见绒毛结构形成(白箭头所示)(HE ×50)
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