骨原发性恶性纤维组织细胞瘤的影像学诊断及鉴别诊断.doc

骨原发性恶性纤维组织细胞瘤的影像学诊断及鉴别诊断
【摘要】目的研究骨原发性恶性纤维组织细胞瘤的影像学表现及诊断要点. 方法回顾性分析9例经手术和病理证实的骨原发性恶性纤维组织细胞瘤的X线、CT及MR的影像学特征及临床资料. 结果原发性骨恶性纤维组织细胞瘤好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端,影像学表现呈多种多样,为溶骨性骨质破坏,并伴有明显软组织肿块,,3例胫骨上端,1例位于肋骨,下颌骨1例,1例为多骨多发. 结论骨原发性恶性纤维组织细胞瘤影像学表现及临床特征缺乏特异性. 若在长骨或其它骨出现溶骨性骨质破坏,并伴有巨大软组织肿块,无骨膜反应,.
【关键词】骨原发性恶性纤维组织细胞瘤 X线摄影计算机体层摄影磁共振成像诊断
[Abstract] Objective To study the imaging findings and diagnostic value of primary malignant fibrous histiocytoma of bone(PBMFH). Methods The X-ray and CT data and MR imaging findings and clinical data of 9 cases with primary malignant fibrous histiocytoma of bone confirmed by operation and pathology were reviewed retrospectively. Results Most of the PBMFH arose in the metaphysic or the ends of long bone. The distal femur or prosimal humerus are the most frequently involved. All the imaging findings of malignant bone tumors were revealed. The imaging appeared as osteolytic bone destruction change and soft tissue mass. It is rare for periosteal reaction. The lesions involved single bone in 8 cases and multiple bones in 1 case. The distal femur was seen in 3 cases, prosimal humerus in 3 cases, rib in 1 case, mandible in 1 case and multiple bone was showed in 1 case. Conclusion The CT of PBMFH usually did not show characteristic findings. The diagnosis of PBMFH should be take into consideration if the osteolytic bone destruction arise in long bone with large soft tissue mass and no for periosteal re
avtion. The confirmed diagnosis of PBMFH must be depended on the operation and pathology.
[Key words] primary malignant fibrous histiocytoma of bone(PBMFH); computed tomography;ic resonance imaging.
骨原发性恶性纤维组织细胞瘤是一种少见的恶性肿瘤。因其临床及影像学表现缺乏特异性,易与骨肉瘤、纤维肉瘤、骨巨细胞瘤相混淆,术前诊断困难。现收集我院自2000年9月至2007年5月共收治9例经手术及病理证实的病例,报告如下:
材料与方法
本组病例男性5例,女性4例,年龄6岁~67岁,,其中40岁以下为6例。临床症状均出现不程度疼痛伴有局部软组织肿块,部分病例为持续性疼痛加重伴有体重下降。病程为2个月至1年不等,平均为5个月。实验室及辅助检查:5例患者血ESR增快,3例患者碱性磷酸酶增高,2例为血白细胞总数升高、单核细胞百分比上升。
9例均行X线摄片检查、其中5例行CT检查、2例行