腱鞘纤维瘤的影像表现及临床病理特征

Imaging and Clinicopathologic Features of Fibroma of Tendon Sheath

摘要: 目的：探讨腱鞘纤维瘤(FTS)的影像表现及临床病理特征，提高本病影像诊断及鉴别水平。方法：回顾性分析本院经病理证实的19例FTS患者的临床、影像及病理资料，总结其特征。结果：19例患者均为单发。位于足部7例(36.8%)，位于手部6例(31.6%)，位于肘关节3例(15.8%)，位于膝关节、踝关节及颈部各1例(5.3%)。14例(87.5%)病灶呈结节状或肿块状。病灶长径9~57 mm，平均29.5 mm。CT表现：5例病灶均呈边界清楚的软组织密度影，增强扫描明显强化。MRI表现：病灶T1WI多呈等或低信号，T2WI可为略低、等或略高信号，11例(84.6%)病灶在T2WI序列内部可见低信号区，其中索条状或细丝状9例(81.8%)，增强扫描呈环形强化。病理表现，镜下观察FTS由稀疏散在的纤维母细胞、狭长的裂隙样血管及大量致密的胶原纤维组成。免疫组化，SMA、MSA、CD10可呈阳性，结蛋白、S‐100蛋白及EMA多呈阴性，Ki67阳性率常小于5%。结论：FTS具有一定的影像学特征，常发生于四肢末端关节周围，X线平片及CT表现为边界清楚的结节状或肿块状软组织密度影，邻近骨质破坏少见，MRI平扫T1WI常呈等低信号，T2WI可为略低、等或略高信号，病灶内常见条带状或细丝状低信号，增强扫描多见环形强化，但确诊仍需依靠病理检查。

Abstract: Objective: To investigate the imaging and clinicopathological features of fibroma of tendon sheath (FTS) in order to improve the imaging diagnosis and differentiation of this disease. Methods: The clinical data, pathological types, and imaging findings of 19 cases with FTS confirmed by pathology were analyzed retrospectively. Results: All the 19 cases of FTS were single lesion, among which 7 (36.8%) cases were located foot, 6 (31.6%) in the hand, 3 (15.8%) in the elbow joint, 1 (5.3%) in the knee joint, 1 (5.3%) in the ankle joint and 1 (5.3%) in the neck. The shape of lesion was round or ovoid in 14 (87.5%) cases. The maximum diameter of the lesions was 9 mm~57 mm, with an average of 29.5 mm. CT manifestations: all five cases showed homogeneous iso-density or slightly lower density than the surrounding soft tissue, clear boundary, and the enhanced imaging showed markedly enhanced solid mass. MRI manifestations: most of the cases showed iso-intensity or slightly hypo-intensity on T1WI. The presentation was varied on T2WI. In 11 (84.6%) cases, low signal area was found in T2WI sequence, including 9 cases (81.8%) with striped and filamentous configurations. Enhanced T1WI, lesion revealed ring enhancement. FTS consists of scattered spindle-shaped fibroblasts, slit-like spaces or thin-walled vessels and a large number of dense collagenous sclerotic stroma. Immunohistochemistry for SMA, MSA and CD10 was mostly positive, with desmin, S100 and EMA negative, and the positive rate of Ki67 is usually less than 5%. Conclusion: FTS has certain imaging characteristics, often occurring around the extremities of the extremities. X-ray and CT show clear boundary nodular or mass soft tissue density, and calcification and adjacent bone destruction are rare. Most of the cases showed iso-intensity or slightly hypo-intensity on T1WI, the presentation was varied on T2WI. Striped and filamentous low signal was common in the lesion, revealed ring enhancement. However, the final diagnosis still depends on the histopathological examination.