摘要
目的探讨胸腹部滤泡树突细胞肉瘤(FDCS)的临床表现、病理特征、CT及MRI表现,提高对该病影像学的认识,减少漏诊、误诊的发生。方法回顾性分析2015年1月至2023年12月浙江大学附属第一医院收治经手术病理证实的18例胸腹部经典型FDCS或肝脾Epstein-Barr病毒(EBV)阳性炎性滤泡树突状细胞肉瘤(EBV+IFDCS)患者的临床资料,16例行CT平扫+增强检查,13例行MRI平扫+增强检查;分析FDCS及EBV+IFDCS患者的临床表现、CT表现、MRI表现、病理特征和复发、转移情况。结果18例FDCS中5例为经典型FDCS,3例来源于十二指肠旁淋巴结,1例位于胰尾部,1例位于右前上纵隔,均为单发类圆形或椭圆形肿块,1例可见钙化,5例均见囊变、坏死,呈不均匀轻中度持续强化,未见包膜结构;13例EBV+IFDCS,10例位于脾脏,3例位于肝脏;均为单发边缘清晰的肿块,呈圆形或卵圆形,1例可见钙化,9例可见坏死、囊变,肿瘤实质成分呈不均匀轻中度持续强化,2例来源于肝脏的呈明显强化,静脉期强化程度有减退;多数可见低信号/低密度包膜且包膜延迟强化。经典型FDCS及EBV+IFDCS肿瘤实性成分DWI均呈高信号,ADC图呈低信号,DWI及ADC信号与相应脾脏信号相仿。结论经典型FDCS是罕见的中度恶性肿瘤,易复发、转移,多表现为边缘清晰的单发肿块,无包膜结构,较大肿块多合并坏死、囊变,偶见钙化,增强后呈不均匀持续强化;而EBV+IFDCS是罕见的低度恶性肿瘤,多发生于肝脾,无临床症状,多为单发肿块,较大肿块多合并坏死、囊变,偶见钙化,发生于肝脾病变强化方式不一致,多数在T2WI图像上可见环状低信号包膜且包膜呈延迟强化,经典型FDCS及EBV+IFDCS肿瘤实性成分DWI均呈高信号,ADC图呈低信号,与相应脾脏一致,有助于诊断和鉴别诊断;MRI对FDCS和EBV+IFDCS诊断更有优势及价值,可以作为首选检查方法,为临床诊断及术前评估提供重要依据。
Objective To investigate the clinical manifestations,pathological features,CT,and MRI findings of follicular dendritic cell sarcoma(FDCS)of the chest and abdomen,improve the understanding of imaging of the disease,and reduce the occurrence of missed diagnosis and misdiagnosis.Methods The clinical data of 18 patients with typical FDCS or Epstein-Barr virus(EBV)-positive inflammatory follicular dendritic cell sarcoma of liver and spleen(EBV+IFDCS)confirmed by operation and pathology in the First Affiliated Hospital of Zhejiang University from January 2015 to December 2023 were retrospectively analyzed.Among the patients,16 patients underwent plain CT scan+enhanced examination,and 13 patients underwent MRI plain scan+enhanced examination.The clinical manifestations,CT manifestations,MRI manifestations,pathological features,recurrence,and metastasis of patients with FDCS and patients with EBV+IFDCS were analyzed.Results Among the 18 cases,5 were typical FDCS,with 3 cases in paraduodenal lymph nodes,1 case in the tail of the pancreas,and 1 case in the right anterior superior mediastinum;all the 5 cases showed single round or oval mass;one case showed calcification;all the 5 cases showed cystic change and necrosis,with uneven mild to moderate continuous enhancement but no envelope structure.Among the 18 cases,13 were confirmed as EBV+IFDCS,located in spleen(10 cases)and liver(3 cases);all the 13 cases showed single tumors with clear edges,round or oval in shape;one case showed calcification;nine cases showed necrosis and cystic change,with uneven mild to moderate continuous enhancement in the tumor parenchymal components;two cases originating from the liver showed significant enhancement,with a decrease in the degree of enhancement during the venous phase;most cases showed low signal/low density envelope and delayed envelope enhancement.The DWI of tumor parenchymal compo-nents of typical FDCS and EBV+IFDCS showed high signal,and the ADC pattern showed low signal;the DWI and ADC signals were similar to the corresponding spleen signals.Conclusion Typical FDCS is a rare moderate malignant tumor,prone to recurrence and metastasis,most of which are single masses,with clear edges and no envelope structure.Larger masses are often complicated with necrosis,cystic change,and occasional calcification,and show uneven and continuous enhancement after enhancement.However,EBV+IFDCS is a rare low-grade malignant tumor,mostly occur-ring in the liver and spleen without clinical symptoms.They were mostly single mass.Large mass are often combined with necrosis,cystic change,and occasional calcification,which occurs in the liver and spleen lesions with different en-hancement methods.Most of them can be seen on T2WI images with circular low-signal envelope and delayed enhance-ment of the envelope.The DWI of tumor parenchymal components of typical FDCS and EBV+IFDCS showed high sig-nal and ADC showed low signal,consistent with the corresponding spleen,which was helpful for diagnosis and differen-tial diagnosis.MRI has more advantages and value in the diagnosis of FDCS and EBV+IFDCS and can be used as the preferred examination method to provide an important basis for clinical diagnosis and preoperative evaluation.
作者
陈阳阳
岳军艳
李培恒
付义彬
陈峰
CHEN Yang-yang;YUE Jun-yan;LI Pei-heng;FU Yi-bin;CHEN Feng(Department of Radiology,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,Henan,CHINA;Department of Radiology,the First Affiliated Hospital of Zhejiang University,Hangzhou 310003,Zhejiang,CHINA)
出处
《海南医学》
CAS
2024年第21期3148-3154,共7页
Hainan Medical Journal
基金
河南省医学科技攻关计划项目(编号:LHGJ20200487)。
关键词
滤泡树突细胞肉瘤
体层摄影术
X线计算机
磁共振成像
临床表现
病理特征
Follicular dendritic cell sarcoma
Tomography
X-ray computer
Magnetic resonance imaging
Clin-ical manifestations
Pathological features
